NPIMap

Organization Active NPI

Athens-Oconee Skin Cancer & Dermatology, LLC

  • Procedural Dermatology Physician
  • Watkinsville, GA
National Provider Identifier
1790989291
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Procedural Dermatology PhysicianTaxonomy code 207NS0135X
License
050931 Issued in GA
Legal business name
ATHENS-OCONEE SKIN CANCER & DERMATOLOGY, LLC
Practice address
1582 Mars Hill Rd
Suite a
Watkinsville, GA 30677-4836
Phone
(706) 769-7546
Fax
(706) 769-2443
NPI assigned
Jun 11, 2007
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Stella Maries Bulengo, M.D.NPI 1194717447
Title
Owner
Phone
(706) 769-7546

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 050931 GA
Dermatopathology Physician 207ND0900X 050931 GA
Procedural Dermatology Physician 207NS0135X 050931 GA Primary

Addresses

Primary practice location

1582 Mars Hill Rd
Suite a
Watkinsville, GA 30677-4836

Mailing address

1582 Mars Hill Rd
Suite a
Watkinsville, GA 30677-4836
Phone (706) 769-7546

Other identifiers 2

IdentifierTypeStateIssuer
1194717447OtherNPI INDIVIDUAL
050931OtherGALICENSE

Other names 1

  • OCONEE DERMATOPATHOLOGY Other name

National Provider Directory

National Provider Directory

Locations

1582 Mars Hill Rd
Ste A
Watkinsville, GA 30677
Phone (706) 769-6530

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1181520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1790989291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1582 MARS HILL RD",
            "address_2": "SUITE A",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306774836",
            "telephone_number": "706-769-7546",
            "fax_number": "706-769-2443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1582 MARS HILL RD",
            "address_2": "SUITE A",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306774836",
            "telephone_number": "706-769-7546",
            "fax_number": "706-769-2443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATHENS-OCONEE SKIN CANCER & DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-11",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "BULENGO",
        "authorized_official_first_name": "STELLA",
        "authorized_official_middle_name": "MARIES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-769-7546",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "GA",
            "license": "050931",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "GA",
            "license": "050931",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "GA",
            "license": "050931",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI INDIVIDUAL",
            "identifier": "1194717447",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "050931",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OCONEE DERMATOPATHOLOGY",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Watkinsville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.