NORTHWEST GEORGIA DERMATOLOGY & SKIN SURGERY CENTER PC (NPI# 1467641381) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467641381 |
| Entity Type | Organization |
| Organization Name | NORTHWEST GEORGIA DERMATOLOGY & SKIN SURGERY CENTER PC |
| Practice Address |
103 John Maddox Dr Nw Rome GA 30165-1419 |
| Practice Telephone | 7062357711 |
| Practice Fax Number | 7062359944 |
| Mailing Telephone | 7062357711 |
| Mailing Fax Number | 7062359944 |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2011-10-19 |
| Authorized Official Name | JASON L SMITH (OWNER/PRESIDENT) |
| Authorized Official Telephone | 7062357711 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
032302 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 000398384A | 05 |
| Street Address |
103 JOHN MADDOX DR NW |
| City | ROME |
| State | GA |
| Zip Code | 30165-1419 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578586400 | Jason L Smith | Dermatology | 103 John Maddox Dr Nw, Rome, GA 30165-1419 | 2006-07-25 |
| 1265812879 | Tricia Nicole Collins | Nurse Practitioner | 103 John Maddox Dr Nw, Rome, GA 30165-1419 | 2015-06-09 |
| 1144642844 | Dora Mciver Broom | Physician Assistant | 103 John Maddox Dr Nw, Rome, GA 30165-1419 | 2014-01-14 |
| 1912180670 | Christin T Swift | Physician Assistant | 103 John Maddox Dr Nw, Rome, GA 30165-1419 | 2007-12-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346868775 | Heather Bowman | Physical Therapist | 600 Eagle, E Lake Dr, Rome, GA 30165 | 2020-07-13 |
| 1205451101 | Kristopher Nelson | Student in an Organized Health Care Education/Training Program | 4256, 304 Shorter Ave Nw #201, Rome, GA 30165 | 2020-06-16 |
| 1962061457 | Stuart Paul Shaklee | Occupational Therapy Assistant | 1356 Redmond Road, Rome, GA 30165 | 2019-06-10 |
| 1386001055 | Autumn Streetman | Counselor | 6 Mathis Drive, Rome, GA 30165 | 2016-01-26 |
| 1144695784 | Gabrador Milligan | Counselor | 6 Mathis Road, Rome, GA 30165 | 2015-12-08 |
| 1386041952 | Theresa Suits | Registered Nurse | 1 Woodbine Avenue, Rome, GA 30165 | 2014-11-26 |
| 1942561147 | Nicole C. Christian | Clinical Neuropsychologist | 305 Redmond Rd, Rome, GA 30165 | 2012-06-04 |
| 1679832711 | Niki Pareshkumar Bhavsar | Internal Medicine | 3041 Turner Mccall Blvd, Rome, GA 30165 | 2012-05-10 |
| 1285927491 | Amanda Fischer Reeves | Family Medicine | 304 Shorter Ave Nw Ste 102, Rome, GA 30165 | 2011-05-20 |
| 1033436647 | Northland Hearing Centers, Inc. | Hearing Instrument Specialist | 4 Coosawattee Ave, Rome, GA 30165 | 2010-04-23 |
| Find all providers in zip 30165 | ||||
| Taxonomy Code | 207NS0135X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | Procedural Dermatology |
| Procedural Dermatology, a subspecialty of Dermatology, encompassing a wide variety of surgical procedures and methods to remove or modify skin tissue for health or cosmetic benefit. These methods include scalpel surgery, laser surgery, chemical surgery, cryosurgery (liquid nitrogen), electrosurgery, aspiration surgery, liposuction, injection of filler substances, and Mohs micrographic controlled surgery (a special technique for the removal of growths, especially skin cancers). |
| Notes: Source: American Board of Dermatology, 2007, www.abderm.org [1/1/2008: definition added, source added, title changed] Additional Resources: Some ABMS board certified dermatologists have completed a one-year ACGME approved fellowship in Procedural Dermatology, which has been offered since 2003. At this time the ABD does not offer subspecialty certification in Procedural Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578586400 | Jason L Smith | Dermatology | 103 John Maddox Dr Nw, Rome, GA 30165-1419 | 2006-07-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326237520 | Larry H Pierce Md PC | Dermatology | 1267 Interstate Pkwy, Augusta, GA 30909-6481 | 2007-10-24 |
| 1891824108 | Tanda Nichole Lane | Dermatology | 1210 Brookstone Centre Pkwy, Columbus, GA 31904-2954 | 2007-03-04 |
| 1801959101 | South Fulton Dermatology Associates,llp | Dermatology | 2719 Felton Dr, East Point, GA 30344-3603 | 2006-12-18 |
| 1295818672 | Robert Mcclure IIi | Dermatology | 5024 Lawrenceville Hwy Nw, Lilburn, GA 30047-4914 | 2006-10-23 |
| 1952495558 | Larry H. Pierce | Dermatology | 1267 Interstate Pkwy., Augusta, GA 30909 | 2006-10-03 |
| 1023082005 | Abdul Hafeez | Dermatology | 631 Professional Dr Ste 110, Lawrenceville, GA 30046-3367 | 2006-02-15 |
| 1205138757 | Amanda Eileen Harpring | Dermatology | 3379 Peachtree Rd Ne, Suite 500, Atlanta, GA 30326-1031 | 2010-12-02 |
| 1538396577 | Center for Dermatology, LLC | Dermatology | 631 Professional Dr Ste 110, Lawrenceville, GA 30046-3367 | 2009-06-17 |
| 1114100377 | Cole Dermatology & Aesthetic Center, P.C. | Dermatology | 3655 Howell Ferry Rd, Ste 400, Duluth, GA 30096-3186 | 2007-12-11 |
| 1780872556 | Atlanta Skin and Aesthetics | Dermatology | 5671 Peachtree Dunwoody Rd Ste 660, Atlanta, GA 30342-5006 | 2007-10-05 |
| Find all providers with the same taxonomy | ||||
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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.