Active NPI 1831385897 Individual Practitioner Male Practitioner

Dr. Johnathan Langston Chappell , MD

Dermatology • Acworth, GA

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Johnathan Chappell, MD is a certified Dermatology practicing in Acworth, GA. With approximately 22 years of clinical experience since graduating from Morehouse School Of Medicine in 2004, Dr. Chappell delivers high-quality medical care to the local community at 4450 CALIBRE XING NW.

Dr. Chappell accepts Medicare assignment.

Frequently performed procedures and clinical services include established patient outpatient office visit, destruction of up to 14 skin growths, new patient outpatient office visit. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

4450 Calibre Xing Nw
Suite 1208

Acworth, GA 301014103

Telephone 6785058030

Fax 6785058263

Associated Practice Facility / Clinic

🏢 Roul R. Sircar M.d., P.c. Facility NPI 1215107016

Medicare Profile & Education

Medical School

Morehouse School Of Medicine

Graduation Year

2004

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Dermatology in Acworth, GA

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

22 Yrs Matches City Avg

City Avg: 22.0 Yrs

State Avg: 24.5 Yrs

Regional Practice Density

1 Specialists

Practicing in Acworth, GA (364 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

46.3% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Chappell (22 Years) 22 Yrs

Acworth Specialty Average (22.0 Years) 22.0 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
99213 Established patient office or other outpatient visit, typically 15 minutes	493	366	$145.38	$90.12
17110 Destruction of up to 14 skin growths	228	195	$181.97	$105.04
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	167	167	$178.49	$110.41
17003 Destruction of precancer skin growth, 2-14 growths	159	56	$10.57	$6.55
17000 Destruction of skin growth	146	125	$108.46	$50.47
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	40	28	$659.78	$408.78
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	39	34	$1087.70	$561.33
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	38	32	$204.08	$124.82
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	27	24	$194.19	$104.79
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	22	21	$680.46	$239.38
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	21	20	$218.40	$122.58
11104 Punch biopsy, first skin growth	19	19	$200.14	$124.25
17313 Removal and microscopic exam of growth of trunk, arms, or legs, 1-5 tissue blocks	18	17	$1022.73	$633.26
10060 Simple or single drainage of skin abscess	16	15	$203.65	$126.50
11102 Tangential biopsy of single skin lesion	15	14	$160.26	$89.54
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	15	12	$218.76	$122.21
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	15	15	$266.90	$157.29
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	13	11	$90.11	$56.06
17314 Removal and microscopic exam of growth of trunk, arms, or legs, each additional stage, 1-5 tissue blocks	13	11	$633.28	$392.05
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	12	11	$750.27	$252.02
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	11	11	$184.17	$98.82

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	478	321	$136.00	$90.21
17003 Destruction of precancer skin growth, 2-14 growths	226	68	$10.15	$6.72
17110 Destruction of up to 14 skin growths	220	167	$172.89	$106.25
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	187	187	$168.92	$112.61
17000 Destruction of skin growth	159	132	$101.97	$48.68
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	36	22	$626.24	$416.69
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	36	34	$192.33	$126.38
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	32	28	$1031.26	$621.93
11102 Tangential biopsy of single skin lesion	30	28	$154.61	$75.53
11104 Punch biopsy, first skin growth	27	27	$191.76	$121.87
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	26	22	$154.56	$73.29
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	22	22	$186.36	$118.30
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	20	18	$718.43	$251.11
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	19	17	$649.13	$329.40
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	17	16	$85.23	$56.76
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	17	17	$177.72	$101.15
17313 Removal and microscopic exam of growth of trunk, arms, or legs, 1-5 tissue blocks	15	14	$969.02	$644.34
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	13	13	$187.54	$124.98
11305 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.5 cm or less	12	12	$161.46	$84.99
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	11	11	$606.95	$330.21
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	11	11	$209.22	$139.19

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	428	293	$137.45	$90.58
17003 Destruction of precancer skin growth, 2-14 growths	302	71	$10.37	$6.79
17110 Destruction of up to 14 skin growths	231	190	$174.27	$105.20
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	210	210	$169.77	$110.43
17000 Destruction of skin growth	168	133	$102.81	$48.74
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	37	31	$189.26	$99.08
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	33	22	$657.29	$415.39
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	33	28	$1159.36	$650.91
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	30	25	$707.91	$321.62
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	24	22	$193.89	$128.29
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	23	18	$158.25	$55.32
11102 Tangential biopsy of single skin lesion	22	21	$157.74	$81.19
10060 Simple or single drainage of skin abscess	20	20	$190.71	$123.09
11104 Punch biopsy, first skin growth	20	20	$195.99	$120.34
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	19	19	$793.51	$342.21
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	15	15	$180.45	$115.61
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	13	11	$85.73	$57.00
11305 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.5 cm or less	11	11	$165.99	$70.13
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	11	11	$390.11	$124.44
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	11	11	$190.31	$96.15

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	382	257	$138.15	$92.58
17003 Destruction of precancer skin growth, 2-14 growths	302	73	$9.94	$6.59
17110 Destruction of up to 14 skin growths	248	184	$173.95	$109.75
17000 Destruction of skin growth	174	132	$100.77	$46.27
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	150	150	$169.88	$112.15
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	72	33	$627.19	$423.04
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	53	38	$1032.20	$623.58
11104 Punch biopsy, first skin growth	36	34	$199.28	$131.42
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	31	25	$735.10	$263.55
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	29	27	$85.39	$57.24
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	20	18	$182.36	$104.26
11102 Tangential biopsy of single skin lesion	19	18	$159.14	$93.16
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	19	17	$195.75	$131.56
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	18	18	$665.34	$374.28
11305 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.5 cm or less	16	11	$167.25	$80.21
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	16	16	$190.83	$124.69
10060 Simple or single drainage of skin abscess	13	12	$189.25	$127.09
11105 Punch biopsy, each additional skin growth	11	11	$93.30	$62.98

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17110 Destruction of up to 14 skin growths	267	189	$171.33	$107.29
17003 Destruction of precancer skin growth, 2-14 growths	187	56	$9.20	$6.14
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	178	158	$165.47	$110.02
17000 Destruction of skin growth	162	120	$99.89	$43.64
99213 Established patient office or other outpatient visit, typically 15 minutes	157	119	$114.09	$76.07
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	109	109	$163.85	$109.36
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	62	57	$69.20	$46.15
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	59	33	$610.82	$408.01
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	50	42	$1018.46	$564.46
99202 New patient office or other outpatient visit, typically 20 minutes	41	41	$115.71	$77.21
11102 Tangential biopsy of single skin lesion	37	36	$153.50	$76.16
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	34	30	$153.50	$73.78
11104 Punch biopsy, first skin growth	34	33	$192.96	$128.73
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	27	25	$734.67	$290.66
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	26	24	$177.83	$109.57
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	21	16	$661.67	$347.40
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	18	17	$186.48	$114.08
10060 Simple or single drainage of skin abscess	17	16	$185.97	$120.69
11305 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.5 cm or less	11	11	$161.61	$88.22

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17110 Destruction of up to 14 skin growths	245	159	$177.50	$106.77
17003 Destruction of precancer skin growth, 2-14 growths	194	40	$15.16	$5.76
99213 Established patient office or other outpatient visit, typically 15 minutes	185	141	$119.09	$74.53
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	135	117	$173.37	$109.24
17000 Destruction of skin growth	103	67	$117.17	$41.62
99202 New patient office or other outpatient visit, typically 20 minutes	100	100	$121.98	$76.57
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	89	78	$71.54	$45.62
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	73	44	$630.28	$400.30
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	69	69	$174.19	$108.35
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	60	51	$1070.29	$478.96
11102 Tangential biopsy of single skin lesion	41	37	$154.30	$78.41
11104 Punch biopsy, first skin growth	23	22	$192.23	$123.57
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	20	19	$153.92	$77.03
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	19	19	$1266.22	$795.61
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	17	16	$695.50	$310.96
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	16	14	$778.77	$291.55
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	15	14	$193.44	$113.88
17313 Removal and microscopic exam of growth of trunk, arms, or legs, 1-5 tissue blocks	13	12	$999.54	$613.12
13131 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 1.1-2.5 cm	11	11	$634.64	$362.40

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17110 Destruction of up to 14 skin growths	167	118	$165.00	$109.36
17003 Destruction of precancer skin growth, 2-14 growths	154	38	$15.00	$5.34
99213 Established patient office or other outpatient visit, typically 15 minutes	137	97	$110.00	$72.32
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	88	77	$162.00	$107.15
17000 Destruction of skin growth	79	59	$113.00	$46.48
99202 New patient office or other outpatient visit, typically 20 minutes	79	79	$112.00	$75.39
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	75	39	$580.00	$385.21
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	56	44	$988.00	$432.77
11100 Biopsy of single growth of skin and/or tissue	53	49	$154.00	$88.87
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	49	45	$66.00	$44.10
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	40	40	$163.00	$108.72
99201 New patient office or other outpatient visit, typically 10 minutes	39	39	$65.00	$44.82
15260 Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)	12	12	$1536.00	$1026.51

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	214	40	$15.00	$6.30
17110 Destruction of up to 14 skin growths	122	88	$165.00	$120.63
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	110	60	$545.60	$406.94
99201 New patient office or other outpatient visit, typically 10 minutes	105	105	$65.00	$48.47
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	98	80	$928.65	$501.38
99213 Established patient office or other outpatient visit, typically 15 minutes	94	69	$110.00	$79.69
17000 Destruction of skin growth	88	59	$113.00	$54.63
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	70	58	$66.00	$47.40
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	58	46	$162.00	$115.67
11100 Biopsy of single growth of skin and/or tissue	39	38	$153.54	$89.96
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	39	39	$163.00	$119.71
99202 New patient office or other outpatient visit, typically 20 minutes	23	23	$112.00	$79.96
15260 Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)	19	19	$1448.08	$1068.27
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	19	18	$587.80	$273.75
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	18	17	$643.82	$256.44
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	16	16	$1142.81	$712.70
17313 Removal and microscopic exam of growth of trunk, arms, or legs, 1-5 tissue blocks	12	12	$803.38	$478.26
14040 Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.0 sq cm or less	11	11	$1078.66	$836.56

Medical Specialties & State Licenses

Dermatology Primary Specialty

NUCC Taxonomy Code: 207N00000X

State License GA 056975

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 DC MD036880

Dermatology - MOHS-Micrographic Surgery

NUCC Taxonomy Code: 207ND0101X

State License GA 056975

The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S.

Pathology - Dermatopathology

NUCC Taxonomy Code: 207ZD0900X

State License GA 056975

A dermatopathologist is an expert in diagnosing and monitoring 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 light microscopy, electron microscopy, and fluorescence microscopy.

Dermatology - Pediatric Dermatology

NUCC Taxonomy Code: 207NP0225X

State License GA 056975

A pediatric dermatologist has, through additional special training, developed expertise in the treatment of specific skin disease categories with emphasis on those diseases which predominate in infants, children and adolescents.

Dermatology - Procedural Dermatology

NUCC Taxonomy Code: 207NS0135X

State License GA 056975

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).

General Practice

NUCC Taxonomy Code: 208D00000X

State License GA 056975

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

Dermatology - Dermatopathology

NUCC Taxonomy Code: 207ND0900X

State License GA 056975

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.

Practice Associates & Co-Workers

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

2 Associated Practitioners

Dr. Roul Sircar , MD

Internal Medicine

NPI 1336146174

Doctor of Medicine (M.D.)

Sydney Galvin

Nurse Practitioner - Family

NPI 1871128256

Career & Practice History Timeline

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

6 Historical Events

✅

NPI Profile Active April 22, 2015

NPI status registered as active in NPPES database

📍

Updated Practice Location April 22, 2015

Registered at 4450 CALIBRE XING NW, SUITE 1208, ACWORTH, GA 301014103 (Tel: 6785058030)

📍

Updated Business Mailing Address April 22, 2015

Registered at 4450 CALIBRE XING NW, SUITE 1208, ACWORTH, GA 301014103 (Tel: 6785058030)

👤

Provider Name / Credentials Updated April 22, 2015

Recorded as JOHNATHAN CHAPPELL, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) April 22, 2015

Dermatology (License #056975 in GA)

🟢

Initial NPI Registration & Enumeration September 23, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1831385897

Entity Type:

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

Enumeration Date: September 23, 2007

Last Update: April 22, 2015

Sole Proprietor: No

Update or Correct Profile

Mailing Address

4450 Calibre Xing Nw, Suite 1208

Acworth, GA 301014103

Phone: 6785058030

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

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