SOUTHERN DERMATOLOGY PC (NPI# 1437437837) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437437837 |
| Entity Type | Organization |
| Organization Name | SOUTHERN DERMATOLOGY PC |
| Practice Address |
1805 Herrington Rd Building 3, Suite A Lawrenceville GA 30043-7987 |
| Practice Telephone | 7708172592 |
| Practice Fax Number | 6783778167 |
| Mailing Telephone | 7708172592 |
| Mailing Fax Number | 6783778167 |
| Enumeration Date | 2011-08-02 |
| Last Update Date | 2011-09-28 |
| Authorized Official Name | DR. WINFRED DERRICK MOODY (OWNER) |
| Authorized Official Telephone | 7708172592 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 045299 | GA | Allopathic & Osteopathic Physicians |
| Street Address |
1805 HERRINGTON RD BUILDING 3, SUITE A |
| City | LAWRENCEVILLE |
| State | GA |
| Zip Code | 30043-7987 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780784454 | Nasira R. Ali | Psychiatry & Neurology | 1805 Herrington Rd, Bldg. 1 Suite A, Lawrenceville, GA 30043-7987 | 2006-09-23 |
| 1205372877 | Krisnir Corporation | Internal Medicine | 1805 Herrington Rd, Bldg# 2, Lawrenceville, GA 30043-7987 | 2017-01-06 |
| 1013319847 | Gwinnett Psychology, LLC | Psychologist | 1805 Herrington Rd, Bldg. 2, Lawrenceville, GA 30043-7987 | 2014-09-24 |
| 1548513963 | Cassin Cole-straub | Psychologist | 1805 Herrington Rd, Bldg. 2, Lawrenceville, GA 30043-7987 | 2012-10-23 |
| 1932394855 | New Life Psychology Services, LLC | Psychologist | 1805 Herrington Rd, Building 2, Lawrenceville, GA 30043-7987 | 2007-09-13 |
| 1760690960 | Rachel Kelli Lacy | Clinical Neuropsychologist | 1805 Herrington Rd, Building 3, Ste. 3-b, Lawrenceville, GA 30043-7987 | 2007-05-19 |
| 1861513673 | Mary E Melton, Phd, PC | Psychologist | 1805 Herrington Rd, #2, Lawrenceville, GA 30043-5649 | 2007-04-02 |
| 1124159405 | Rachel E. Christian, Ph.d., P.C. | Psychologist | 1805 Herrington Rd, Bldg. 2, Lawrenceville, GA 30043-5649 | 2007-03-08 |
| 1285789222 | Joseph Henry Fallon Jr. | Psychologist | 1805 Herrington Rd, Bldg 2, Lawrenceville, GA 30043-5649 | 2007-01-23 |
| 1205995487 | Gerda R Abbey | Psychologist | 1805 Herrington Rd, Building #2, Lawrenceville, GA 30043-5649 | 2006-12-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609483882 | Brittany Javier Dunn | Counselor | 2387 Lawrenceville Huntcrest Way, Lawreneville, GA 30043 | 2020-09-30 |
| 1629614037 | Terrea Gina Bridges | Behavior Technician | 2387 Huntcrest Rd, Lawrenceville, GA 30043 | 2019-11-20 |
| 1215581756 | Elegant Lm Management, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1020 Meadowsong Circle, Lawrenceville, GA 30043 | 2019-08-01 |
| 1093299778 | Shareef Nahas | Clinical Medical Laboratory | 1130 Hurricane Shoals Rd, Suite 1800, Lawrenceville, GA 30043 | 2018-09-19 |
| 1649766874 | Nutritionecw LLC | Dietitian, Registered | 1755 North Brown Rd, Ste.200, Lawrenceville, GA 30043 | 2018-07-11 |
| 1962997965 | David Le Nguyen | Dentist | 2000 Riverside Pkwy Ste 200, Lawrenceville, GA 30043 | 2018-06-22 |
| 1932611688 | Asfc Outreach Therapeutic Counseling Services, LLC | Counselor | 1755 North Brown Road, Suite 200, Lawrenceville, GA 30043 | 2017-11-02 |
| 1518486810 | Shira Brey Williams | Specialist/Technologist | 1030 Collins Hill Rd, Lawrenceville, GA 30043 | 2017-09-18 |
| 1700300795 | Nympha J. Mathurin Meadows | Behavioral Analyst | 650 Oxford Crest Ct, Lawrenceville, GA 30043 | 2017-08-01 |
| 1992245591 | Jagruti Chaudhari | Nurse Practitioner | 855 Buford Drive, Lawrenceville, GA 30043 | 2017-03-01 |
| Find all providers in zip 30043 | ||||
| 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 |
|---|---|---|---|---|
| 1205308616 | Belle Lumiere Cosmetics LLC | Dermatology | 753 Old Norcross Road, Lawrenceville, GA 30046 | 2018-12-24 |
| 1477031318 | Wellness Dermatology LLC | Dermatology | 638 Lawrenceville Rd, Lawrenceville, NJ 08648-4208 | 2018-08-02 |
| 1740600048 | Kenyatta Mireku | Dermatology | 771 Old Norcross Rd Ste 260, Lawrenceville, GA 30046-4981 | 2014-04-24 |
| 1770586430 | Steven L Hubert | Dermatology | 74 Franklin Corner Rd, Lawrenceville, NJ 08648-2102 | 2005-05-24 |
| 1710401203 | Leah Celia Kincaid | Dermatology | 3311 Brunswick Pike, Lawrenceville, NJ 08648-2411 | 2017-07-27 |
| 1780062661 | Kehinde Oladunni Raji | Dermatology | 771 Old Norcross Rd Ste 260, Lawrenceville, GA 30046-4981 | 2015-05-12 |
| 1063736833 | David Elliot Roffwarg | Dermatology | 771 Old Norcross Rd, Suite 260, Lawrenceville, GA 30046-4386 | 2010-03-22 |
| 1740424035 | Lusia S Yi | Dermatology | 3311 Brunswick Pike, Lawrenceville, NJ 08648-2411 | 2009-04-30 |
| 1639325194 | Jodi D Langer-kaufmann | Dermatology | 771 Old Norcross Rd, Suite 260, Lawrenceville, GA 30046-4386 | 2008-08-14 |
| 1154483139 | North Georgia Dermatology, P.C. | Dermatology | 771 Old Norcross Rd, Suite 260, Lawrenceville, GA 30046-4386 | 2006-12-15 |
| Find all providers in LAWRENCEVILLE | ||||
| City | LAWRENCEVILLE |
| Zip Code | 30043 |
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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.