Jonathan David Pewitt, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

065413 Issued in GA

Practice address

835 Cogburn Avenue
Suite 100
Marietta, GA 30060-1008

Phone

(770) 422-5557

Fax

(770) 422-5456

NPI assigned

Aug 6, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

East Tennessee State University Quillen College of Medicine, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aqua Dermatology of Georgia PCGroup PAC ID 6800885757, 56 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Aqua Dermatology of Georgia PC

  • Dermatology Physician
  • Marietta, GA
  • NPI 1114022167
  Medicare reassignment Care Compare group NPD
• Dermatopathology Lab of Skin Cancer Specialists, P.C.

  • Clinical Medical Laboratory
  • Marietta, GA
  • NPI 1083044465
  NPD
• Harbin Clinic, LLC

  • Ambulatory Surgical Clinic/Center
  • Rome, GA
  • NPI 1447385158
  NPD

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

{
    "created_epoch": "1186358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680134400000",
    "number": "1912198979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "835 COGBURN AVENUE",
            "address_2": "SUITE 250",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601010",
            "telephone_number": "770-422-8815",
            "fax_number": "770-422-8816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 COGBURN AVENUE",
            "address_2": "SUITE 100",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601008",
            "telephone_number": "770-422-5557",
            "fax_number": "770-422-5456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEWITT",
        "first_name": "JONATHAN",
        "middle_name": "DAVID",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-06",
        "last_updated": "2023-03-30",
        "certification_date": "2023-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "GA",
            "license": "065413",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003108826A",
            "state": "GU"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sierra Peterson
• Cynthia Petrella, APRN
• Karen Marise Petrella, DDS
• Michael Petrosky, MD
• Douglas B Pettit, DC
• Aidiem Pham
• Loc B Pham, MD
• Robert V Pham, MD
• Christy Phan
• Lam Trong Phan, PA

• Dermatology Physician in Marietta, GA
• Providers in Marietta, 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 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.