NPIMap

Organization Active NPI

Daec, Inc

  • Dermatology Physician
  • Marietta, GA
National Provider Identifier
1962767954
Registry record updated Jul 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
DAEC, INC
Practice address
4939 Lower Roswell Rd
Suite 104a
Marietta, GA 30068-4338
Phone
(404) 816-7900
Fax
(404) 816-7929
NPI assigned
Jul 6, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2012

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

Authorized official

Name
Virginia Rutledge Forney, M.D.NPI 1316941644
Title
President/Owner
Phone
(404) 816-7900

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
SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 174400000X
Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207N00000X Primary
Procedural Dermatology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207NS0135X

Addresses

Primary practice location

4939 Lower Roswell Rd
Suite 104a
Marietta, GA 30068-4338

Mailing address

PO Box 52226
Atlanta, GA 30355-0226
Phone (404) 816-7900

Other names 1

  • Dermatology Affiliates East Cobb Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2283206Dermatology Affiliates, PC4939 Lower Roswell Road, Suite 104, Marietta, GA 30068Certificate of waiverJun 1, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1341532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341532800000",
    "number": "1962767954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 52226",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303550226",
            "telephone_number": "404-816-7900",
            "fax_number": "404-816-7929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4939 LOWER ROSWELL RD",
            "address_2": "SUITE 104A",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300684338",
            "telephone_number": "404-816-7900",
            "fax_number": "404-816-7929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAEC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-06",
        "last_updated": "2012-07-06",
        "status": "A",
        "authorized_official_last_name": "FORNEY",
        "authorized_official_first_name": "VIRGINIA",
        "authorized_official_middle_name": "RUTLEDGE",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "404-816-7900",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dermatology Affiliates East Cobb",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.