NPIMap

Organization Active NPI

Dermatology Affiliates, LLC

  • Specialist
  • Atlanta, GA
National Provider Identifier
1730244872
Registry record updated Aug 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
044218 Issued in GA
Legal business name
DERMATOLOGY AFFILIATES, LLC
Practice address
3131 Maple Dr NE
Suite 102
Atlanta, GA 30305
Phone
(404) 816-7900
Fax
(404) 816-7929
NPI assigned
Dec 27, 2006
Last updated
Aug 17, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Virginia Rutledge Forney, MDNPI 1316941644
Title
Director/Officer
Phone
(404) 816-7900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 044218 GA Primary

Addresses

Primary practice location

3131 Maple Dr NE
Suite 102
Atlanta, GA 30305

Mailing address

PO Box 734465
Dallas, TX 75373-4465
Phone (404) 816-7900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040713000970 GA Part B Supplier - Clinic/Group Practice 5799763975 Receives reassigned benefits from 20 practitioners
Practice locations: Atlanta, GA; Marietta, GA; Watkinsville, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2309942Dermatology Affiliates Research Institute3131 Maple Drive, NE, Suite 201, Atlanta, GA 30305Certificate of waiverAug 22, 2026

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

107 W Paces Ferry Rd NW
Atlanta, GA 30305
Phone (866) 460-3246

691 14th St NW
Ste E
Atlanta, GA 30318

4939 Lower Roswell Rd
Ste 104
Marietta, GA 30068

4939 Lower Roswell Rd
Ste 104A
Marietta, GA 30068

1220 Langford Dr
Bldg 100
Watkinsville, GA 30677

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 30

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786924800000",
    "number": "1730244872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 734465",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753734465",
            "telephone_number": "404-816-7900",
            "fax_number": "404-816-7929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3131 MAPLE DR NE",
            "address_2": "SUITE 102",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30305",
            "telephone_number": "404-816-7900",
            "fax_number": "404-816-7929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY AFFILIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2026-08-17",
        "certification_date": "2026-08-17",
        "status": "A",
        "authorized_official_last_name": "FORNEY",
        "authorized_official_first_name": "VIRGINIA",
        "authorized_official_middle_name": "RUTLEDGE",
        "authorized_official_title_or_position": "DIRECTOR/OFFICER",
        "authorized_official_telephone_number": "404-816-7900",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "044218",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.