NPIMap

Organization Active NPI

Dermatology Associates of Tallahassee, PA

  • Dermatology Physician
  • Valdosta, GA
National Provider Identifier
1730567504
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
DERMATOLOGY ASSOCIATES OF TALLAHASSEE, PA
Practice address
4233 Camelot Xing
Valdosta, GA 31602-6926
Phone
(229) 469-4383
Fax
(229) 469-4584
NPI assigned
May 13, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Stephen Richardson, MDNPI 1710918404
Title
Board Secretary
Phone
(850) 877-4134

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
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

4233 Camelot Xing
Valdosta, GA 31602-6926

Mailing address

PO Box 13834
Tallahassee, FL 32317-3834
Phone (850) 205-6232

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150914001567 GA Part B Supplier - Clinic/Group Practice 6608775499 Receives reassigned benefits from 13 practitioners
Practice locations: Albany, GA; Bainbridge, GA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

4727 Sunbeam Rd
Jacksonville, FL 32257
Phone (904) 512-1899

3009 4th St
Marianna, FL 32446
Phone (850) 526-3937

425 W 19th St
Ste D
Panama City, FL 32405

616 State Road 13 N
St Johns, FL 32259
Phone (850) 205-6232

25 State Road 13 N
St Johns, FL 32259
Phone (904) 265-8209

1516 E Evans St
Bainbridge, GA 39819
Phone (229) 246-4888

Practitioners & affiliated clinicians

Practitioners 61

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 61

NPI Registry JSON

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

{
    "created_epoch": "1431475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1730567504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13834",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323173834",
            "telephone_number": "850-205-6232",
            "fax_number": "850-402-9130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4233 CAMELOT XING",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316026926",
            "telephone_number": "229-469-4383",
            "fax_number": "229-469-4584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY ASSOCIATES OF TALLAHASSEE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-13",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "BOARD SECRETARY",
        "authorized_official_telephone_number": "850-877-4134",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valdosta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.