Metroderm, P.C.
Organization Active NPI Specialist · Gainesville, GA
NPI 1942929062 · NPPES record last updated Aug 23, 2022
Key facts
- NPI
- 1942929062
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 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
- Organization subpart
- Yes
- Parent organization (as reported)
- METRODERM, P.C.
Authorized official
- Name
- Carrie Williams
- Title
- Director of Revenue
- Phone
- (678) 904-2359
Parent organization (reported in NPPES) 1
Other NPIs on the same Medicare enrollment 1
Practitioners 38
-
Corrie Vanexel Alford, M.D.
-
Jack L Arbiser, MD
-
Inga Elita Bennett, NP-C
-
Adar Berghoff, MD
-
Raymond Vincent Caputo, M.D.
-
Laura C Garvey, M.D.
-
Gregory Trey Haunson, D.O.
-
Victoria Johnson, PA-C
-
Robert M Kelleher, M.D.
-
Amy E Kim, MD
-
Long Ly, MD
-
Robert McClure III, M.D.
-
Jodi-Ann Camille Moore, P.A.
-
Farzad Nahai, M.D.
-
Foad Nahai, M.D.
-
Julia Pettersen Neckman, M.D.
-
Eileen S Niren, MD
-
Maya Patel, PA-C
-
Ashley Nicole Patterson, M.D.
-
Lori Plonski, MD
-
Daniel C. Rabb, MEDICAL DOCTOR
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Part of
- Metroderm PC
Locations
3155 North Point Pkwy
Ste 100
Alpharetta, GA 30005
Phone (770) 475-6222
148 Bill Carruth Pkwy
Ste 280
Hiram, GA 30141
Phone (678) 363-3342
4374 Atlanta Hwy
Ste 103
Hiram, GA 30141
Phone (770) 726-1277
4150 Five Forks Trickum Rd SW
Ste 3
Lilburn, GA 30047
Phone (470) 842-3516
875 Johnson Fy Rd NE
Ste 300
Sandy Springs, GA 30342
Phone (404) 257-9933
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | Yes |
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
Other providers in Gainesville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 23, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.