Active NPI 1770549701 Individual Practitioner Male Practitioner

Myles Sidney Jerdan , MEDICAL DOCTOR

Dermatology • Lagrange, GA

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Myles Jerdan, MEDICAL DOCTOR is a certified Dermatology practicing in Lagrange, GA. With approximately 47 years of clinical experience since graduating from University Of Illinois College Of Med (Chi/Peor/Rock/Chm-Urb) in 1979, Myles Jerdan delivers high-quality medical care to the local community at 1605 WHITESVILLE ST.

Myles Jerdan is affiliated with Dermatology Specialists Of Georgia Llc and accepts Medicare assignment.

Frequently performed procedures and clinical services include ultrasonic guidance for placement of radiation therapy fields, obtaining data needed to develop the optimal radiation treatment, 1 treatment area, radiation treatment delivery, superficial. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

1605 Whitesville St

Lagrange, GA 302405903

Telephone 8772313376

Fax 8505228354

Associated Practice Facility / Clinic

🏢 West Georgia Dermatology Pc Facility NPI 1760493167

Medicare Profile & Education

Medical School

University Of Illinois College Of Med (Chi/peor/rock/chm-Urb)

Graduation Year

1979

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Dermatology in Lagrange, GA

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

47 Yrs Matches City Avg

City Avg: 47.0 Yrs

State Avg: 24.5 Yrs

Regional Practice Density

2 Specialists

Practicing in Lagrange, GA (364 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

63.9% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Jerdan (47 Years) 47 Yrs

Lagrange Specialty Average (47.0 Years) 47.0 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
G6001 Ultrasonic guidance for placement of radiation therapy fields	2,005	95	$440.03	$168.03
77280 Obtaining data needed to develop the optimal radiation treatment, 1 treatment area	1,883	85	$913.75	$251.01
77401 Radiation treatment delivery, superficial	1,846	85	$140.94	$38.39
17003 Destruction of precancer skin growth, 2-14 growths	992	153	$15.00	$6.06
99213 Established patient office or other outpatient visit, typically 15 minutes	881	298	$212.00	$89.51
17000 Destruction of skin growth	314	201	$157.29	$43.99
77336 Continuing radiation therapy consultation per week	255	72	$195.00	$82.75
11103 Biopsy of related skin growth, each additional growth	203	103	$114.89	$46.75
11102 Tangential biopsy of single skin lesion	185	164	$226.00	$81.21
17110 Destruction of up to 14 skin growths	179	137	$256.00	$101.52
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	149	119	$131.00	$55.37
77300 Calculation of radiation therapy dose	137	81	$222.98	$63.44
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	67	36	$781.20	$386.67
11104 Punch biopsy, first skin growth	63	56	$282.00	$118.25
77261 Simple radiation therapy planning	59	54	$174.12	$70.10
77285 Obtaining data needed to develop the optimal radiation treatment, 2 treatment areas	51	29	$1397.99	$409.17
77332 Design and construction of simple radiation treatment device	50	42	$90.48	$38.22
96573 Application of light by qualified health care professional to destroy precancer skin growth	49	34	$515.00	$206.71
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	41	41	$261.00	$110.13
77334 Design and construction of complex radiation treatment device	35	26	$427.88	$119.62
17004 Destruction of precancer skin growth, 15 or more growths	33	30	$380.00	$161.29
77262 Intermediate radiation therapy planning	32	28	$366.56	$108.51
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	30	30	$299.00	$123.83
11105 Punch biopsy, each additional skin growth	26	22	$135.00	$57.03
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	24	16	$38.00	$0.95
11755 Biopsy of fingernail or toenail	22	18	$279.00	$104.92
77333 Design and construction of intermediate radiation treatment device	19	19	$462.29	$129.65
69100 Biopsy of ear	18	14	$217.00	$56.30
11900 Injection into skin growth, 1-7 growths	15	12	$131.00	$35.12
99202 New patient office or other outpatient visit, typically 20 minutes	15	15	$167.00	$70.88
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	12	12	$1077.00	$456.93

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	960	150	$14.97	$6.05
G6001 Ultrasonic guidance for placement of radiation therapy fields	636	33	$399.00	$163.04
77280 Obtaining data needed to develop the optimal radiation treatment, 1 treatment area	589	32	$680.17	$243.46
77401 Radiation treatment delivery, superficial	587	30	$90.00	$36.69
99213 Established patient office or other outpatient visit, typically 15 minutes	492	282	$209.00	$84.17
17000 Destruction of skin growth	308	207	$153.00	$41.45
11102 Tangential biopsy of single skin lesion	246	200	$229.00	$76.78
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	207	156	$130.00	$53.15
11103 Biopsy of related skin growth, each additional growth	195	109	$115.80	$45.23
17110 Destruction of up to 14 skin growths	170	136	$256.00	$97.59
77427 Radiation treatment management, 5 treatments	113	30	$656.58	$184.24
77336 Continuing radiation therapy consultation per week	88	26	$189.00	$77.23
11104 Punch biopsy, first skin growth	71	63	$285.00	$114.62
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	66	40	$840.96	$384.88
77300 Calculation of radiation therapy dose	56	33	$147.59	$61.41
17004 Destruction of precancer skin growth, 15 or more growths	48	37	$385.00	$154.07
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	47	47	$260.00	$102.29
96573 Application of light by qualified health care professional to destroy precancer skin growth	44	37	$507.00	$207.58
77261 Simple radiation therapy planning	43	22	$223.09	$68.16
11755 Biopsy of fingernail or toenail	35	24	$281.00	$85.30
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	33	27	$38.00	$0.91
11105 Punch biopsy, each additional skin growth	30	25	$135.12	$54.04
11900 Injection into skin growth, 1-7 growths	29	23	$130.00	$32.18
77332 Design and construction of simple radiation treatment device	28	20	$88.00	$35.91
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	28	26	$641.00	$187.35
69100 Biopsy of ear	27	22	$220.00	$56.74
99202 New patient office or other outpatient visit, typically 20 minutes	25	25	$167.00	$66.85
11643 Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips	22	21	$726.00	$247.56
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	19	19	$296.00	$117.27
77334 Design and construction of complex radiation treatment device	19	12	$351.90	$115.98
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	18	17	$1147.54	$387.74
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	18	17	$1084.00	$436.96
11623 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 2.1-3.0 cm	17	16	$682.00	$262.52
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	15	12	$1050.88	$359.55
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	14	12	$614.00	$206.35
11604 Removal of cancer skin growth of body, arms, or legs, 3.1-4.0 cm	13	12	$714.00	$224.86
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	13	13	$472.00	$185.79

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	983	138	$14.00	$6.16
99213 Established patient office or other outpatient visit, typically 15 minutes	492	261	$182.00	$84.95
17000 Destruction of skin growth	259	171	$135.00	$40.70
11102 Tangential biopsy of single skin lesion	258	205	$204.00	$81.31
11103 Biopsy of related skin growth, each additional growth	240	130	$102.00	$47.19
17110 Destruction of up to 14 skin growths	151	114	$225.00	$99.03
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	115	87	$256.00	$120.90
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	100	100	$227.00	$105.73
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	73	34	$784.96	$381.44
11104 Punch biopsy, first skin growth	70	63	$253.00	$116.00
17004 Destruction of precancer skin growth, 15 or more growths	65	45	$335.00	$156.87
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	56	56	$338.00	$155.38
96573 Application of light by qualified health care professional to destroy precancer skin growth	43	30	$456.00	$208.08
11755 Biopsy of fingernail or toenail	40	25	$248.00	$98.70
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	37	19	$12.00	$1.13
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	33	29	$561.00	$180.28
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	33	26	$858.00	$371.05
87220 Tissue fungi or parasites	31	24	$22.00	$4.09
11105 Punch biopsy, each additional skin growth	23	16	$119.00	$55.94
11643 Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips	19	16	$637.00	$260.52
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	19	16	$540.00	$227.72
11900 Injection into skin growth, 1-7 growths	18	16	$114.00	$40.13
69100 Biopsy of ear	18	15	$194.00	$61.11
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	16	14	$953.00	$450.84
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	16	15	$114.00	$48.14
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	15	14	$802.00	$353.86
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	13	12	$490.00	$189.85

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,030	153	$12.00	$5.87
99213 Established patient office or other outpatient visit, typically 15 minutes	521	267	$169.00	$86.46
17000 Destruction of skin growth	304	184	$123.00	$43.90
11102 Tangential biopsy of single skin lesion	285	212	$193.00	$85.19
11103 Biopsy of related skin growth, each additional growth	276	127	$97.00	$49.03
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	154	117	$240.00	$122.95
17110 Destruction of up to 14 skin growths	104	82	$210.00	$96.32
17004 Destruction of precancer skin growth, 15 or more growths	94	65	$303.00	$153.19
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	93	93	$208.00	$106.75
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	62	36	$779.98	$389.89
11104 Punch biopsy, first skin growth	61	54	$239.00	$113.96
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	47	32	$12.00	$1.28
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	44	44	$313.00	$162.10
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	38	29	$521.00	$176.49
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	34	27	$889.00	$441.29
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	30	25	$804.00	$413.10
96573 Application of light by qualified health care professional to destroy precancer skin growth	30	25	$428.00	$215.79
11901 Injection into skin growth, more than 7 growths	28	24	$129.00	$55.28
11105 Punch biopsy, each additional skin growth	28	19	$112.00	$57.42
J0702 Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg	27	13	$25.78	$6.75
87220 Tissue fungi or parasites	21	17	$22.00	$4.27
11643 Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips	21	17	$596.00	$224.68
11755 Biopsy of fingernail or toenail	19	16	$235.00	$105.07
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	17	14	$105.00	$50.84
69100 Biopsy of ear	17	13	$181.00	$60.63
11900 Injection into skin growth, 1-7 growths	17	13	$104.00	$42.40
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	17	17	$503.00	$181.97
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	15	14	$26.00	$13.44
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	14	11	$751.00	$385.23
96574 Application of light with debridement to destroy precancer skin growth	14	13	$527.00	$267.34
11604 Removal of cancer skin growth of body, arms, or legs, 3.1-4.0 cm	13	11	$584.00	$207.41

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	914	162	$19.59	$5.63
99213 Established patient office or other outpatient visit, typically 15 minutes	415	251	$130.86	$71.32
88305 Pathology examination of tissue using a microscope, intermediate complexity	357	149	$90.00	$28.83
17000 Destruction of skin growth	299	219	$114.19	$43.70
11102 Tangential biopsy of single skin lesion	292	228	$160.90	$84.61
11103 Biopsy of related skin growth, each additional growth	208	114	$88.35	$50.10
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	96	96	$135.83	$102.15
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	87	33	$6.31	$1.48
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	86	65	$70.06	$43.16
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	82	79	$175.00	$102.77
17110 Destruction of up to 14 skin growths	72	62	$188.46	$97.47
17004 Destruction of precancer skin growth, 15 or more growths	66	54	$322.71	$148.53
99202 New patient office or other outpatient visit, typically 20 minutes	56	56	$131.75	$72.43
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	29	25	$463.76	$256.88
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	27	23	$432.15	$173.87
11900 Injection into skin growth, 1-7 growths	24	21	$98.00	$39.52
69100 Biopsy of ear	21	16	$176.19	$62.50
11901 Injection into skin growth, more than 7 growths	20	12	$104.00	$58.01
11623 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 2.1-3.0 cm	20	14	$504.45	$236.51
11104 Punch biopsy, first skin growth	18	18	$196.44	$113.53
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	15	14	$473.13	$181.19
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	15	12	$874.00	$459.12
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	14	14	$402.00	$194.45
11622 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	13	12	$463.62	$179.07
11643 Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips	13	12	$540.08	$259.67

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	205	36	$21.06	$5.24
88305 Pathology examination of tissue using a microscope, intermediate complexity	99	53	$90.00	$27.03
11103 Biopsy of related skin growth, each additional growth	66	32	$62.69	$51.11
11102 Tangential biopsy of single skin lesion	64	57	$121.54	$85.57
17000 Destruction of skin growth	55	44	$95.38	$41.12
99213 Established patient office or other outpatient visit, typically 15 minutes	52	38	$99.97	$70.83
17004 Destruction of precancer skin growth, 15 or more growths	26	20	$232.04	$147.39
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	22	22	$135.00	$100.57
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	21	19	$125.47	$104.36
99202 New patient office or other outpatient visit, typically 20 minutes	19	19	$125.00	$70.90
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	14	14	$48.30	$44.09

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	137	22	$5.76	$5.33
11100 Biopsy of single growth of skin and/or tissue	54	37	$105.48	$98.17
11101 Biopsy of each additional growth of skin and/or tissue	50	21	$33.48	$32.95
99213 Established patient office or other outpatient visit, typically 15 minutes	48	37	$74.16	$72.97
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	48	34	$44.28	$43.58
17000 Destruction of skin growth	30	25	$68.04	$50.04
17004 Destruction of precancer skin growth, 15 or more growths	29	18	$153.36	$145.91

Medical Specialties & State Licenses

CMS Verified: 2020-08-28

Dermatology Primary Specialty

NUCC Taxonomy Code: 207N00000X

State License GA 30796

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.

Dermatology

NUCC Taxonomy Code: 207N00000X

State License TN 60136

Dermatology

NUCC Taxonomy Code: 207N00000X

State License GA D30796

Dermatology - Dermatopathology

NUCC Taxonomy Code: 207ND0900X

State License GA 030796

A dermatopathologist has the expertise to diagnose and monitor diseases of the skin including infectious, immunologic, degenerative and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings and smears of skin lesions by means of routine and special (electron and fluorescent) microscopes.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID

Q053605 (TN)

Hospital & Practice Group Affiliations

Dermatology Specialists Of Georgia Llc

1605 Whitesville St, Lagrange, GA 302405903

Phone: 8772313376

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners

Sophia Georges , AGNP-C

Nurse Practitioner

NPI 1003668971

Adult-Gerontology Nurse Practitioner (Certified)

Angela Pearson , NP

Nurse Practitioner

NPI 1013267608

Nurse Practitioner

Dr. Jeffrey Stricker , DO

Dermatology - MOHS-Micrographic Surgery

NPI 1013973692

Doctor of Osteopathic Medicine (D.O.)

Holly Vezertzis , CRNP

Nurse Practitioner - Adult Health

NPI 1033532874

Certified Registered Nurse Practitioner

Tricia Berry , ARNP

Nurse Practitioner

NPI 1043370240

Advanced Registered Nurse Practitioner

Elizabeth Dylewski

Physician Assistant

NPI 1053136945

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

15 Historical Events

📍

Updated Practice Location August 28, 2020

Registered at 1605 WHITESVILLE ST, LAGRANGE, GA 302405903 (Tel: 8772313376)

📍

Updated Business Mailing Address August 28, 2020

Registered at 2505 HARRISON AVE, PANAMA CITY, FL 324054464 (Tel: 8502333376)

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) August 28, 2020

Dermatology (License #30796 in GA)

📍

Updated Practice Location August 04, 2020

Registered at 123 FOX RD, KNOXVILLE, TN 379223369 (Tel: 8656909467)

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) August 04, 2020

Dermatology (License #60136 in TN)

📍

Updated Business Mailing Address November 04, 2019

Registered at 123 FOX RD, KNOXVILLE, TN 379223369 (Tel: 8656909467)

📍

Updated Practice Location July 30, 2018

Registered at 2045 PEACHTREE RD NE STE 200, ATLANTA, GA 30309 (Tel: 4043517546)

📍

Updated Business Mailing Address July 30, 2018

Registered at 4800 OLDE TOWNE PKWY STE 250, MARIETTA, GA 300684428 (Tel: 7709713376)

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) July 30, 2018

Dermatology (License #030796 in GA)

✅

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

📍

Updated Practice Location July 08, 2007

Registered at 900 CAMPBELL HILL STREET, MARIETTA, GA 30060 (Tel: 7704221013)

📍

Updated Business Mailing Address July 08, 2007

Registered at 900 CAMPBELL HILL STREET, MARIETTA, GA 30060 (Tel: 7704221013)

👤

Provider Name / Credentials Updated July 08, 2007

Recorded as MYLES JERDAN, MEDICAL DOCTOR

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dermatology (License #D30796 in GA)

🟢

Initial NPI Registration & Enumeration April 26, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1770549701

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: April 26, 2006

Last Update: August 28, 2020

Sole Proprietor: No

Update or Correct Profile

Mailing Address

2505 Harrison Ave

Panama City, FL 324054464

Phone: 8502333376

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.