South Georgia Dermatology, PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

044059 Issued in GA

Legal business name

SOUTH GEORGIA DERMATOLOGY, PC

Practice address

802 18TH St E
Tifton, GA 31794-3661

Phone

(229) 386-9333

Fax

(229) 386-1666

NPI assigned

Dec 14, 2006

Last updated

Aug 22, 2020By 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

Kristyn Elizabeth Renfroe

Title

Practice Manager

Phone

(229) 386-9333

Specialties & licenses 1

Addresses

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.

• Robert Jay Muterspaugh, PA-C

  • Physician Assistant
  • Tifton, GA
  • NPI 1124020425
  NPD (past)
• Frank John Pinto Jr., MD

  • Dermatology Physician
  • Norwalk, CT
  • NPI 1043212350
  NPD (past)

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770645228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 18TH ST E",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943661",
            "telephone_number": "229-386-9333",
            "fax_number": "229-386-1666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 18TH ST E",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943661",
            "telephone_number": "229-386-9333",
            "fax_number": "229-386-1666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH GEORGIA DERMATOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RENFROE",
        "authorized_official_first_name": "KRISTYN",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "229-386-9333"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "GA",
            "license": "044059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tina Marie Snow, LMT
• Vinod Kumar Reddy Solipuram
• South Ga Orthopedic Resources Inc
• South Georgia CSB (Behavioral Health Svcs of S GA)
• South Georgia CSB (Tift C&A Outpatient Services)
• South Georgia Drug Company LLC (Friendly City Pharmacy)
• South Georgia Eye Partners
• South Georgia Eye Partners PC
• South Georgia Medicine, P.C.
• South Georgia Neurological Associates, P.C.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.