Kenyatta Mireku (NPI# 1740600048, PAC ID# 3971819780) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is DERMATOLOGY.
| Nation Provider ID (NPI) | 1740600048 |
| PAC ID by PECOS | 3971819780 |
| Professional Enrollment ID | I20180926003098 |
| Full Name | Kenyatta Mireku |
| Organization Legal Name | ADVANCED DERMATOLOGY OF GEORGIA, LLC |
| Address |
2089 Teron Trce Suite 200 Dacula GA 30019-1609 |
| Phone Number | 7709625040 |
| Gender | F |
| Medical School | MEDICAL COLLEGE OF GEORGIA |
| Graduation Year | 2014 |
| Primary Specialty | DERMATOLOGY |
| Group Practice PAC ID | 9638485782 |
| Number of Group Practice Members | 12 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 2089 Teron Trce, Suite 200, Dacula, GA 30019-1609 | 7709625040 | ADVANCED DERMATOLOGY OF GEORGIA, LLC |
| 771 Old Norcross Rd, Suite 260, Lawrenceville, GA 30046-4981 | 7709625040 | ADVANCED DERMATOLOGY OF GEORGIA, LLC |
| Organization Legal Name | ADVANCED DERMATOLOGY OF GEORGIA, LLC |
| Physicians | 11 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| David E Roffwarg | Dermatology | Advanced Dermatology of Georgia, LLC | 2089 Teron Trce, Suite 200, Dacula, GA 30019-1609 |
| Sidney S Curry | Dermatology | Advanced Dermatology of Georgia, LLC | 771 Old Norcross Rd, Suite 260, Lawrenceville, GA 30046-4981 |
| Kevin K Bush | Physician Assistant | Advanced Dermatology of Georgia, LLC | 771 Old Norcross Rd, Suite 260, Lawrenceville, GA 30046-4981 |
| Emily T Manley | Physician Assistant | Advanced Dermatology of Georgia, LLC | 771 Old Norcross Rd, Suite 260, Lawrenceville, GA 30046-4981 |
| Jing F Gill | Dermatology | Advanced Dermatology of Georgia, LLC | 771 Old Norcross Rd, Suite 260, Lawrenceville, GA 30046-4981 |
| Jodi D Langer | Dermatology | Advanced Dermatology of Georgia, LLC | 771 Old Norcross Rd, Suite 260, Lawrenceville, GA 30046-4981 |
| Pamela M Mcelearney | Physician Assistant | Advanced Dermatology of Georgia, LLC | 771 Old Norcross Rd, Suite 260, Lawrenceville, GA 30046-4981 |
| Christopher L Bass | Physician Assistant | Advanced Dermatology of Georgia, LLC | 771 Old Norcross Rd, Suite 260, Lawrenceville, GA 30046-4981 |
| Melinda Greenfield | Dermatology | Advanced Dermatology of Georgia, LLC | 771 Old Norcross Rd, Suite 260, Lawrenceville, GA 30046-4981 |
| Noel Gusman Ferrer | Physician Assistant | Advanced Dermatology of Georgia, LLC | 771 Old Norcross Rd, Suite 260, Lawrenceville, GA 30046-4981 |
| Street Address |
2089 TERON TRCE SUITE 200 |
| City | DACULA |
| State | GA |
| Zip | 30019-1609 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| David E Roffwarg | Dermatology | Advanced Dermatology of Georgia, LLC | 2089 Teron Trce, Suite 200, Dacula, GA 30019-1609 |
| Noreen Victoria Zulaica | Physical Therapy | 2089 Teron Trce, Suite 120, Dacula, GA 30019-1609 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Anna L Richardson | Nurse Practitioner | Atlanta Allergy and Asthma, Pa | 2089 Teron Trace, Suite 250, Dacula, GA 30019 |
| Cheryl M Hughes | Clinical Social Worker | 3617 Braselton Hwy, Suite 104, Dacula, GA 30019 | |
| Shirley A Boone-sanford | Psychologist, Clinical | 2078 Teron Trace, Suite 250, Dacula, GA 30019 | |
| Bhairavi Dholakia | Ophthalmology | North Georgia Eye Clinic Inc | 2089 Teron Trace, Suite 160, Dacula, GA 30019 |
| Yadira Nmi Cardona Rohena | Maxillofacial Surgery | 2089 Teron Trace, Suite 215, Dacula, GA 30019 | |
| Lorraine Laura Laplace | Nurse Practitioner | Northeast Georgia Physicians Group Inc | 3575 Braselton Hwy, Dacula, GA 30019-1027 |
| Aishah Boodram | Clinical Social Worker | 3581 Braselton Hwy, Dacula, GA 30019-1027 | |
| Russell Glassman | Chiropractic | Hamilton Mill Family Chiropractic | 3509 Braselton Hwy, Dacula, GA 30019-1027 |
| Elvira Jasarevic | Family Medicine | Northeast Georgia Physicians Group Inc | 3575 Braselton Hwy, Dacula, GA 30019-1027 |
| Jay H Joseph | Cardiovascular Disease (cardiology) | Heart Center LLC | 3575 Braselton Hwy, Dacula, GA 30019-1027 |
| Find all physicians in zip 30019 | |||
| City | DACULA |
| Zip Code | 30019 |
| Specialty | DERMATOLOGY |
| City + Specialty | DACULA + DERMATOLOGY |
Please comment or provide details below to improve the information on Kenyatta Mireku.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.