Riverside Dermatology and Aesthetic Center, PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

70111 Issued in GA

Legal business name

RIVERSIDE DERMATOLOGY AND AESTHETIC CENTER, PC

Practice address

2045 Centre Stone CT
Suite B
Columbus, GA 31904-4571

Phone

(706) 257-4189

NPI assigned

Jul 1, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Jacqueline Nicole Fussell, M.D

Title

Physician

Phone

(706) 257-4189

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1404172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404172800000",
    "number": "1982010716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2045 CENTRE STONE CT",
            "address_2": "SUITE B",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319044571",
            "telephone_number": "706-257-4189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2045 CENTRE STONE CT",
            "address_2": "SUITE B",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319044571",
            "telephone_number": "706-257-4189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE DERMATOLOGY AND AESTHETIC CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-01",
        "last_updated": "2014-07-01",
        "status": "A",
        "authorized_official_last_name": "FUSSELL",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "706-257-4189",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "GA",
            "license": "70111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Columbus, GA
• Providers in Columbus, GA by specialty
• Dermatology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2014; 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.