Active NPI
Samuel D Rauch Jr., M.D.
- Specialist
- Gainesville, GA
National Provider Identifier
1710980776
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 11452
- Practice address
- 1240 Jesse Jewell Pkwy SE
Ste 500
Gainesville, GA 30501-3861 - Phone
- (678) 350-3636
- Fax
- (770) 297-5023
- NPI assigned
- May 24, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 11452 | GA | Primary |
Addresses
Primary practice location
1240 Jesse Jewell Pkwy SE
Ste 500
Gainesville, GA 30501-3861
Mailing address
399 Peninsula Rd
Gainesville, GA 30506-1705
Phone (770) 536-8585
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00086039A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11452 | GA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gwinnett Dermatology PC D/B/a Georgia Dermatology Partners | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dermatology Physician
- Snellville, GA
- NPI 1477596203
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1116892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1710980776",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "399 PENINSULA RD",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "305061705",
"telephone_number": "770-536-8585",
"fax_number": "770-297-5023"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1240 JESSE JEWELL PKWY SE",
"address_2": "STE 500",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "305013861",
"telephone_number": "678-350-3636",
"fax_number": "770-297-5023"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAUCH",
"first_name": "SAMUEL",
"middle_name": "D",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-05-24",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "GA",
"license": "11452",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00086039A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Gainesville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.