NPIMap

Organization Active NPI

Georiga Dermatology Center, P.C.

  • Dermatology Physician
  • Cumming, GA
National Provider Identifier
1942307160
Registry record updated Sep 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
030078 Issued in GA
Legal business name
GEORIGA DERMATOLOGY CENTER, P.C.
Practice address
1505 Northside Blvd
Suite 1500
Cumming, GA 30041-7623
Phone
(770) 781-5077
Fax
(770) 781-3915
NPI assigned
Sep 20, 2006
Last updated
Sep 28, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2016

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

Authorized official

Name
Dr. Alexander S Gross, M.D.NPI 1306826490
Title
Owner
Phone
(770) 781-5077

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 003130 GA
Nurse Practitioner 363L00000X RN164556 GA
Dermatology Physician 207N00000X 030078 GA Primary

Addresses

Primary practice location

1505 Northside Blvd
Suite 1500
Cumming, GA 30041-7623

Mailing address

1505 Northside Blvd
Suite 1500
Cumming, GA 30041-7623
Phone (770) 781-5077

Other identifiers 2

IdentifierTypeStateIssuer
000509858DMedicaidGA
621341781AMedicaidGA

National Provider Directory

National Provider Directory

Locations

1505 Northside Blvd
Ste 1500
Cumming, GA 30041
Phone (770) 781-5077

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475020800000",
    "number": "1942307160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 NORTHSIDE BLVD",
            "address_2": "SUITE 1500",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300417623",
            "telephone_number": "770-781-5077",
            "fax_number": "770-781-3915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 NORTHSIDE BLVD",
            "address_2": "SUITE 1500",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300417623",
            "telephone_number": "770-781-5077",
            "fax_number": "770-781-3915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORIGA DERMATOLOGY CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2016-09-28",
        "status": "A",
        "authorized_official_last_name": "GROSS",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-781-5077",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "003130",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN164556",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "GA",
            "license": "030078",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000509858D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "621341781A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cumming, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2016; 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.