Divine Dermatology & Aesthetics LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

DIVINE DERMATOLOGY & AESTHETICS LLC

Practice address

1039 Grant St SE Ste a-11
Atlanta, GA 30315-2014

Phone

(678) 589-7546

Fax

(678) 589-7500

NPI assigned

Mar 15, 2018

Last updated

Mar 15, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tunisia F. Cornelius, MDNPI 1245404854

Title

Authorized Official

Phone

(678) 589-7546

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 2

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.

• Tunisia Finch Cornelius, M.D.

  • Dermatology Physician
  • Atlanta, GA
  • NPI 1245404854
  Medicare reassignment NPD Authorized official
• Jordan Starr Lopez Dixon, PA-C

  • Physician Assistant
  • Atlanta, GA
  • NPI 1841020963
  Medicare reassignment NPD (past)

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

{
    "created_epoch": "1521072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521072000000",
    "number": "1730682725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 GLENWOOD AVE SE STE 510-209",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303161966",
            "telephone_number": "678-589-7546",
            "fax_number": "678-589-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1039 GRANT ST SE STE A-11",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303152014",
            "telephone_number": "678-589-7546",
            "fax_number": "678-589-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE DERMATOLOGY & AESTHETICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-15",
        "last_updated": "2018-03-15",
        "status": "A",
        "authorized_official_last_name": "CORNELIUS",
        "authorized_official_first_name": "TUNISIA",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "678-589-7546",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diverse Images Management Services LLC,
• Henry Leon Diversi Jr., DMD MSD
• Diversity ABA
• Varada Dinkar Divgi, M.B.B.S. FAAP
• Divine Behavioral Services (One Community Behavioral Services)
• Divine Inclination Psychotherapy and Consulting, LLC
• Divine Intervention Behavioral Solutions LLC
• Divine Path Transit LLC
• Divine Therapy LLC
• Divinity Internal Medicine & Associates Inc.

• Dermatology Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Dermatology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2018; 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.