NPIMap

Organization Active NPI

Metroderm, P.C.

  • Specialist
  • Gainesville, GA
National Provider Identifier
1942929062
Registry record updated Aug 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
METRODERM, P.C.
Practice address
974 S Enota Dr NE
Gainesville, GA 30501-2429
Phone
(770) 536-7546
NPI assigned
Aug 23, 2022
Last updated
Aug 23, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
METRODERM, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 23, 2022

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

Authorized official

Name
Carrie Williams
Title
Director of Revenue
Phone
(678) 904-2359

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

974 S Enota Dr NE
Gainesville, GA 30501-2429

Mailing address

875 Johnson Fy Rd NE Ste 300
Atlanta, GA 30342-1418
Phone (678) 904-2359

Other practice location 1

225 Adams Dr
Demorest, GA 30535-4577
Phone (770) 536-7357

Other practice location 2

134 Ansley Dr Ste 502
Dahlonega, GA 30533-1641
Phone (770) 536-7546

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040503000850 GA Part B Supplier - Clinic/Group Practice 8729076443 Receives reassigned benefits from 48 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Demorest, GA; Lilburn, GA; Hiram, GA; Gainesville, GA; Atlanta, GA; Alpharetta, GA; Dahlonega, GA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Metroderm PC

Locations

3155 North Point Pkwy
Ste 100
Alpharetta, GA 30005
Phone (770) 475-6222

3193 Howell Mill Rd NW
Ste 220
Atlanta, GA 30327
Phone (404) 350-5777

134 Ansley Dr
Ste 502
Dahlonega, GA 30533
Phone (770) 536-7546

875 Johnson Fy Rd NE
Ste 1
Sandy Springs, GA 30342
Phone (404) 257-9933

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 38

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.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1661212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661212800000",
    "number": "1942929062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "875 JOHNSON FY RD NE STE 300",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421418",
            "telephone_number": "678-904-2359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "974 S ENOTA DR NE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305012429",
            "telephone_number": "770-536-7546"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "225 Adams Dr",
            "address_purpose": "LOCATION",
            "city": "Demorest",
            "state": "GA",
            "postal_code": "305354577",
            "country_code": "US",
            "telephone_number": "770-536-7357",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "134 Ansley Dr Ste 502",
            "address_purpose": "LOCATION",
            "city": "Dahlonega",
            "state": "GA",
            "postal_code": "305331641",
            "country_code": "US",
            "telephone_number": "770-536-7546",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "METRODERM, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "METRODERM, P.C.",
        "enumeration_date": "2022-08-23",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "CARRIE",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE",
        "authorized_official_telephone_number": "678-904-2359"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.