LIVE OAK DERMATOLOGY (NPI# 1194209163) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194209163 |
| Entity Type | Organization |
| Organization Name | LIVE OAK DERMATOLOGY |
| Practice Address |
135 Norcross St # 8 Roswell GA 30075-3867 |
| Practice Telephone | 6788702020 |
| Mailing Telephone | 6788702020 |
| Enumeration Date | 2018-09-17 |
| Last Update Date | 2018-09-17 |
| Authorized Official Name | BRENT GOEDJEN (CEO) |
| Authorized Official Telephone | 6788702020 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| Street Address |
135 NORCROSS ST # 8 |
| City | ROSWELL |
| State | GA |
| Zip Code | 30075-3867 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851889539 | William Shelton Green | Specialist/Technologist | 1055 Riceland Ct, Roswell, GA 30075 | 2018-04-27 |
| 1043712524 | Lena Claire Morison | Music Therapist | 12060 Etris Rd. #200, Roswell, GA 30075 | 2018-03-01 |
| 1790232031 | Christina Danielle Dicioccio | Physician Assistant | 11040 Crabapple Rd # Suiea, Roswell, GA 30075 | 2016-09-02 |
| 1720531767 | Arbor Cove Therapy LLC | Social Worker | 981 Canton St, Suite 200-e, Roswell, GA 30075 | 2016-07-26 |
| 1740640887 | Christina C Plaice | Counselor | 10882 Crabapple Road, Suite 2, Roswell, GA 30075 | 2016-03-02 |
| 1215316435 | Jlm X-ray LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 1015 Canton Street, Roswell, GA 30075 | 2015-05-20 |
| 1174953624 | Ellen Terrell | Occupational Therapist | 10050 Crabapple Road, Suite D-115a, Roswell, GA 30075 | 2013-11-20 |
| 1114269974 | Patricia E Hernandez | Nurse Practitioner | 10479 Alpharetta St Ste 18, Roswell, GA 30075 | 2013-03-20 |
| 1750623658 | The George Center Foundation | Music Therapist | 1206 Etris Rd., Suite 200, Roswell, GA 30075 | 2013-03-19 |
| 1407187735 | Rachael Anne Templeton | Chiropractor | 593 Atlanta Street, Gorman Chiropractic, Roswell, GA 30075 | 2010-01-27 |
| Find all providers in zip 30075 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003479254 | Kiley Katherine Fagan | Dermatology | 775 Aronson Lake Ct, Roswell, GA 30075-7172 | 2019-04-15 |
| 1346503810 | Shaanan Satish Shetty | Dermatology | 1265 Upper Hembree Rd Ste 100, Roswell, GA 30076-1258 | 2012-06-20 |
| 1407075880 | Marcus Brian Goodman | Dermatology | 2500 Hospital Blvd Ste 280, Roswell, GA 30076-4918 | 2007-04-24 |
| 1568556017 | John C Henry | Dermatology | 207 N. Union, Suite C, Roswell, NM 88201 | 2006-10-02 |
| 1285730952 | Jack L Graham, Md, PC | Dermatology | 1600 Se Main St Ste E, Roswell, NM 88203-5423 | 2006-09-16 |
| 1902842214 | Harry R. Mccarthy Jr. | Dermatology | 600 Currin Ct, Roswell, GA 30076-3583 | 2006-06-22 |
| 1447259577 | Kenneth Mark Ellner | Dermatology | 1265 Upper Hembree Rd, Suite 100, Roswell, GA 30076-1143 | 2005-07-20 |
| 1265927230 | Jennifer Erin Millsap | Dermatology | 415 E Crossville Rd, Roswell, GA 30075-7626 | 2018-06-22 |
| 1174916365 | Alexandria Bass Glass | Dermatology | 2500 Hospital Blvd Ste 280, Roswell, GA 30076-4918 | 2015-03-11 |
| 1326357799 | Eugene Sanik | Dermatology | 2500 Hospital Blvd, Suite 280, Roswell, GA 30076-4907 | 2010-10-01 |
| Find all providers in ROSWELL | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.