Chattanooga Dermatology PLLC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

Legal business name

CHATTANOOGA DERMATOLOGY PLLC

Practice address

2158 Northgate Park LN Ste 106
Chattanooga, TN 37415-6911

Phone

(423) 888-3376

Fax

(423) 870-1480

NPI assigned

Sep 3, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Jason Susong, MDNPI 1235302787

Title

Owner

Phone

(423) 888-3376

Specialties & licenses 3

Addresses

Other names 1

• Chattanooga Mohs Surgery Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 1

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

• Jason Rodney Susong, MD

  • MOHS-Micrographic Surgery Physician
  • Chattanooga, TN
  • NPI 1235302787

  Dermatology

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1630627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720569600000",
    "number": "1750059622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2158 NORTHGATE PARK LN STE 106",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374156911",
            "telephone_number": "423-888-3376",
            "fax_number": "423-870-1480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2158 NORTHGATE PARK LN STE 106",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374156911",
            "telephone_number": "423-888-3376",
            "fax_number": "423-870-1480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHATTANOOGA DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-03",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A",
        "authorized_official_last_name": "SUSONG",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-888-3376",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chattanooga Mohs Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• MOHS-Micrographic Surgery Physician in Chattanooga, TN
• Providers in Chattanooga, TN by specialty
• MOHS-Micrographic Surgery Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; 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.