Active NPI 1962784785 Individual Practitioner Male Practitioner

Kenneth Ray Johnson , PA-C

Physician Assistant - Surgical • Evans, GA

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Kenneth Johnson, PA-C is a certified Physician Assistant - Surgical practicing in Evans, GA. With approximately 15 years of clinical experience since graduating from Medical College Of Georgia School Of Medicine in 2011, Kenneth Johnson delivers high-quality medical care to the local community at 1203 TOWN PARK LN.

Kenneth Johnson is affiliated with Dermatology Specialists Of Augusta, Inc and accepts Medicare assignment.

Frequently performed procedures and clinical services include destruction of precancer skin growth, 2-14 growths, established patient outpatient office visit, tangential biopsy of single skin lesion. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

1203 Town Park Ln

Evans, GA 30809

Telephone 7066507546

Fax 7069229168

Associated Practice Facility / Clinic

🏢 Dermatology Specialists Of Augusta, Inc Facility NPI 1558339275

Medicare Profile & Education

Medical School

Medical College Of Georgia School Of Medicine

Graduation Year

2011

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant - Surgical in Evans, GA

Established Specialist (10-20 Yrs)

Practitioner Clinical Experience

15 Yrs -5.5 yrs vs City Avg

City Avg: 20.5 Yrs

State Avg: 15.1 Yrs

Regional Practice Density

4 Specialists

Practicing in Evans, GA (539 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

57.8% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Johnson (15 Years) 15 Yrs

Evans Specialty Average (20.5 Years) 20.5 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
17003 Destruction of precancer skin growth, 2-14 growths	4,247	585	$67.96	$5.23
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,416	936	$188.07	$105.56
11102 Tangential biopsy of single skin lesion	1,261	946	$204.72	$68.63
99213 Established patient office or other outpatient visit, typically 15 minutes	1,227	904	$133.08	$74.44
17000 Destruction of skin growth	841	678	$168.92	$34.55
11103 Biopsy of related skin growth, each additional growth	782	426	$109.92	$40.03
17110 Destruction of up to 14 skin growths	702	579	$199.00	$89.07
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	159	128	$301.53	$130.59
17004 Destruction of precancer skin growth, 15 or more growths	144	119	$368.23	$133.73
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	135	117	$409.78	$99.44
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	128	110	$519.61	$243.79
69100 Biopsy of ear	99	91	$203.43	$50.24
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	86	47	$590.80	$388.35
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	75	47	$208.68	$105.11
17111 Destruction of skin growth, 15 or more growths	64	54	$235.00	$106.01
11104 Punch biopsy, first skin growth	52	51	$255.80	$96.86
11200 Removal of skin tag, 1-15 skin tags	47	46	$164.00	$48.40
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	44	41	$84.00	$46.01
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	44	44	$166.00	$91.79
87220 Tissue fungi or parasites	40	35	$29.00	$4.18
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	39	26	$8.00	$0.94
11900 Injection into skin growth, 1-7 growths	28	24	$100.00	$33.09
10060 Simple or single drainage of skin abscess	24	24	$190.00	$95.86
11105 Punch biopsy, each additional skin growth	24	22	$127.00	$47.94
12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less	24	23	$405.00	$210.94
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	23	23	$245.00	$139.11
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	15	15	$465.00	$114.11
40490 Biopsy of lip	14	12	$264.00	$95.98
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	11	11	$318.00	$140.19

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	4,576	599	$66.63	$5.09
99213 Established patient office or other outpatient visit, typically 15 minutes	1,327	948	$132.96	$71.71
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,315	820	$188.05	$101.32
11102 Tangential biopsy of single skin lesion	1,208	878	$203.99	$67.41
17000 Destruction of skin growth	894	692	$167.40	$34.55
17110 Destruction of up to 14 skin growths	697	550	$198.41	$85.98
11103 Biopsy of related skin growth, each additional growth	649	371	$109.44	$39.11
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	157	127	$518.35	$237.85
17004 Destruction of precancer skin growth, 15 or more growths	151	124	$368.33	$131.21
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	144	125	$409.44	$97.95
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	132	97	$301.87	$125.32
69100 Biopsy of ear	86	77	$203.41	$50.61
17111 Destruction of skin growth, 15 or more growths	78	60	$234.67	$103.20
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	74	69	$83.89	$44.59
11104 Punch biopsy, first skin growth	54	54	$255.91	$97.70
11200 Removal of skin tag, 1-15 skin tags	50	48	$164.00	$43.75
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	49	28	$8.00	$1.04
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	48	48	$165.17	$88.55
11900 Injection into skin growth, 1-7 growths	43	27	$100.00	$30.49
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	37	31	$463.53	$121.80
87220 Tissue fungi or parasites	32	31	$29.00	$4.18
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	29	29	$246.33	$133.42
12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less	28	27	$405.00	$198.46
Q0112 All potassium hydroxide (koh) preparations	26	26	$21.92	$5.71
11105 Punch biopsy, each additional skin growth	23	22	$125.56	$46.23
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	19	13	$598.47	$384.82
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	17	13	$209.84	$105.26
10060 Simple or single drainage of skin abscess	11	11	$190.00	$98.61

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	4,676	586	$68.00	$5.24
99213 Established patient office or other outpatient visit, typically 15 minutes	1,548	1,091	$119.74	$72.54
11102 Tangential biopsy of single skin lesion	1,375	988	$205.00	$69.49
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,160	763	$185.00	$102.22
11103 Biopsy of related skin growth, each additional growth	919	488	$110.00	$40.17
17000 Destruction of skin growth	884	675	$169.00	$33.46
17110 Destruction of up to 14 skin growths	654	512	$199.00	$86.66
17004 Destruction of precancer skin growth, 15 or more growths	175	145	$369.00	$132.31
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	158	132	$520.00	$238.12
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	140	118	$410.00	$96.91
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	134	113	$302.00	$126.93
69100 Biopsy of ear	120	99	$204.00	$49.18
17111 Destruction of skin growth, 15 or more growths	73	62	$235.00	$103.64
Q0112 All potassium hydroxide (koh) preparations	71	66	$22.46	$5.76
11104 Punch biopsy, first skin growth	62	56	$257.00	$99.34
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	59	50	$75.31	$45.02
11105 Punch biopsy, each additional skin growth	45	36	$127.00	$47.00
11200 Removal of skin tag, 1-15 skin tags	41	38	$164.00	$47.73
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	41	41	$158.46	$87.61
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	33	20	$8.00	$1.15
11900 Injection into skin growth, 1-7 growths	29	21	$100.00	$28.59
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	25	23	$465.00	$110.45
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	20	20	$236.05	$135.08
12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less	17	14	$405.00	$209.31
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	15	12	$279.00	$68.43
10060 Simple or single drainage of skin abscess	13	13	$190.00	$94.95

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	3,571	505	$68.00	$5.13
11102 Tangential biopsy of single skin lesion	1,339	1,006	$205.00	$71.07
99213 Established patient office or other outpatient visit, typically 15 minutes	1,250	958	$102.00	$74.27
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,220	810	$185.00	$105.26
11103 Biopsy of related skin growth, each additional growth	958	512	$110.00	$41.90
17000 Destruction of skin growth	734	608	$169.00	$32.97
17110 Destruction of up to 14 skin growths	612	493	$199.00	$87.50
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	142	127	$520.00	$247.75
17004 Destruction of precancer skin growth, 15 or more growths	138	111	$369.00	$132.21
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	119	106	$410.00	$101.80
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	111	95	$302.00	$129.72
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	106	98	$67.00	$45.38
87220 Tissue fungi or parasites	102	95	$29.00	$4.23
11104 Punch biopsy, first skin growth	72	70	$257.00	$103.84
17111 Destruction of skin growth, 15 or more growths	69	60	$235.00	$103.90
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	62	62	$230.00	$138.00
11200 Removal of skin tag, 1-15 skin tags	54	51	$164.00	$43.60
11105 Punch biopsy, each additional skin growth	49	40	$127.00	$47.91
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	49	49	$148.00	$88.22
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	45	38	$279.00	$69.82
69100 Biopsy of ear	40	39	$204.00	$49.21
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	36	24	$211.22	$145.17
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	25	15	$8.00	$1.22
12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less	23	20	$405.00	$213.02
11900 Injection into skin growth, 1-7 growths	21	15	$100.00	$35.22
40490 Biopsy of lip	19	18	$264.00	$93.84
11755 Biopsy of fingernail or toenail	19	19	$230.00	$103.05
10060 Simple or single drainage of skin abscess	18	18	$190.00	$97.10

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	3,250	471	$68.00	$4.72
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,299	1,000	$185.00	$88.16
11102 Tangential biopsy of single skin lesion	1,170	892	$193.57	$67.25
17000 Destruction of skin growth	736	583	$169.00	$32.50
11103 Biopsy of related skin growth, each additional growth	691	401	$102.36	$42.05
99213 Established patient office or other outpatient visit, typically 15 minutes	575	428	$102.00	$60.59
17110 Destruction of up to 14 skin growths	535	438	$199.00	$85.54
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	374	324	$67.00	$36.48
99202 New patient office or other outpatient visit, typically 20 minutes	140	140	$102.00	$61.28
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	121	99	$520.00	$239.43
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	115	89	$302.00	$132.21
87220 Tissue fungi or parasites	109	94	$29.00	$4.20
17004 Destruction of precancer skin growth, 15 or more growths	102	85	$369.00	$126.79
11104 Punch biopsy, first skin growth	81	75	$243.69	$97.52
69100 Biopsy of ear	81	76	$204.00	$50.67
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	78	71	$410.00	$99.62
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	62	49	$279.00	$65.82
11105 Punch biopsy, each additional skin growth	55	42	$117.36	$47.52
17111 Destruction of skin growth, 15 or more growths	43	40	$235.00	$104.83
11200 Removal of skin tag, 1-15 skin tags	40	38	$164.00	$42.99
12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less	38	35	$405.00	$198.13
40490 Biopsy of lip	28	27	$264.00	$99.02
10060 Simple or single drainage of skin abscess	27	26	$190.00	$92.45
11755 Biopsy of fingernail or toenail	21	20	$230.00	$94.12
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	18	18	$148.00	$87.61
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	18	16	$465.00	$120.54
67810 Biopsy of eyelid	11	11	$513.00	$143.58

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	3,749	559	$47.07	$4.44
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,421	1,035	$169.64	$87.42
11102 Tangential biopsy of single skin lesion	1,246	952	$193.00	$66.37
17000 Destruction of skin growth	894	678	$169.00	$33.23
11103 Biopsy of related skin growth, each additional growth	707	420	$99.15	$41.90
99213 Established patient office or other outpatient visit, typically 15 minutes	693	498	$102.00	$59.12
17110 Destruction of up to 14 skin growths	632	506	$199.00	$84.64
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	454	385	$67.00	$36.01
99202 New patient office or other outpatient visit, typically 20 minutes	161	161	$102.00	$61.22
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	131	109	$302.00	$125.77
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	121	104	$520.00	$242.73
87220 Tissue fungi or parasites	108	100	$29.00	$4.53
17004 Destruction of precancer skin growth, 15 or more growths	106	90	$369.00	$122.03
69100 Biopsy of ear	83	79	$204.00	$67.30
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	81	73	$279.00	$68.51
11104 Punch biopsy, first skin growth	78	71	$243.00	$94.47
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	77	67	$410.00	$100.12
11200 Removal of skin tag, 1-15 skin tags	56	54	$164.00	$44.05
11105 Punch biopsy, each additional skin growth	50	43	$113.20	$46.89
17111 Destruction of skin growth, 15 or more growths	43	36	$235.00	$104.31
12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less	39	38	$405.00	$196.99
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	30	30	$148.00	$85.39
11755 Biopsy of fingernail or toenail	23	20	$230.00	$96.23
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	17	11	$8.00	$1.62
10060 Simple or single drainage of skin abscess	16	15	$190.00	$89.76
67810 Biopsy of eyelid	13	13	$513.00	$139.57

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	3,738	533	$37.14	$4.05
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,313	942	$147.42	$84.16
11100 Biopsy of single growth of skin and/or tissue	1,294	934	$186.42	$70.26
17000 Destruction of skin growth	878	642	$166.39	$32.31
99213 Established patient office or other outpatient visit, typically 15 minutes	797	549	$100.62	$57.02
11101 Biopsy of each additional growth of skin and/or tissue	674	412	$136.14	$25.59
17110 Destruction of up to 14 skin growths	649	489	$196.39	$84.08
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	348	294	$65.89	$34.23
99202 New patient office or other outpatient visit, typically 20 minutes	259	259	$100.69	$58.83
87220 Tissue fungi or parasites	122	109	$21.43	$5.12
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	121	105	$506.73	$232.45
17004 Destruction of precancer skin growth, 15 or more growths	116	86	$335.81	$112.17
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	100	81	$266.81	$125.16
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	87	75	$385.86	$98.44
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	74	69	$275.19	$65.42
69100 Biopsy of ear	70	67	$201.43	$52.19
11200 Removal of skin tag, 1-15 skin tags	60	54	$161.20	$46.12
12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less	43	41	$397.58	$183.70
17111 Destruction of skin growth, 15 or more growths	33	28	$231.52	$102.73
11755 Biopsy of fingernail or toenail	31	29	$224.97	$103.02
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	27	27	$146.00	$85.37
13120 Complicated repair of wound of scalp, arms, or legs, 1.1-2.5 cm	20	19	$544.00	$274.60
40490 Biopsy of lip	19	17	$258.84	$98.66
10060 Simple or single drainage of skin abscess	19	19	$186.32	$90.77
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	15	11	$6.27	$1.71

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	3,248	472	$36.00	$4.34
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,166	861	$145.00	$84.10
11100 Biopsy of single growth of skin and/or tissue	1,032	778	$185.00	$67.82
17000 Destruction of skin growth	757	582	$165.00	$34.05
99213 Established patient office or other outpatient visit, typically 15 minutes	749	553	$100.00	$57.36
17110 Destruction of up to 14 skin growths	595	470	$195.00	$82.79
11101 Biopsy of each additional growth of skin and/or tissue	513	315	$135.00	$25.77
99202 New patient office or other outpatient visit, typically 20 minutes	170	170	$100.00	$58.94
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	147	140	$65.00	$33.83
17004 Destruction of precancer skin growth, 15 or more growths	119	96	$319.00	$116.31
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	91	76	$251.00	$124.77
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	82	74	$498.00	$227.54
87220 Tissue fungi or parasites	64	59	$18.00	$5.74
11200 Removal of skin tag, 1-15 skin tags	63	62	$160.00	$40.93
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	51	48	$375.00	$93.65
69100 Biopsy of ear	48	45	$200.00	$55.30
17111 Destruction of skin growth, 15 or more growths	47	39	$230.00	$101.21
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	45	41	$273.00	$64.79
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	33	33	$145.00	$85.35
10060 Simple or single drainage of skin abscess	29	27	$183.00	$92.13
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	18	11	$6.00	$1.61
12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less	17	17	$394.00	$185.00
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	15	14	$423.00	$104.11
40490 Biopsy of lip	15	13	$250.00	$101.70
13120 Complicated repair of wound of scalp, arms, or legs, 1.1-2.5 cm	12	12	$540.00	$273.76
67810 Biopsy of eyelid	11	11	$502.00	$132.82

Medical Specialties & State Licenses

Physician Assistant - Surgical Primary Specialty

NUCC Taxonomy Code: 363AS0400X

State License GA 6259

Definition to come...

Physician Assistant - Medical

NUCC Taxonomy Code: 363AM0700X

State License GA 6259

Definition to come...

Hospital & Practice Group Affiliations

Dermatology Specialists Of Augusta, Inc

1203 Town Park Ln, Evans, GA 308093481

Phone: 7066507546

Practice Associates & Co-Workers

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

2 Associated Practitioners

Dr. Sanders Callaway , MD

Dermatology - MOHS-Micrographic Surgery

NPI 1033187703

Doctor of Medicine (M.D.)

Carly Griffies , PA-C

Physician Assistant

NPI 1619638897

Physician Assistant (Certified)

Career & Practice History Timeline

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

7 Historical Events

📍

Updated Practice Location June 29, 2018

Registered at 1203 TOWN PARK LN, EVANS, GA 30809 (Tel: 7066507546)

✅

NPI Profile Active April 19, 2016

NPI status registered as active in NPPES database

📍

Updated Practice Location April 19, 2016

Registered at 1203 TOWN PARK LN, EVANS, GA 308095440 (Tel: 7066507546)

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Updated Business Mailing Address April 19, 2016

Registered at PO BOX 63185, CHARLOTTE, NC 282633001 (Tel: 7066507546)

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Provider Name / Credentials Updated April 19, 2016

Recorded as KENNETH JOHNSON, PA-C

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Medical Taxonomy / Specialty Registered (Primary Specialty) April 19, 2016

Physician Assistant (License #6259 in GA)

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Initial NPI Registration & Enumeration September 19, 2011

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1962784785

Entity Type:

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

Enumeration Date: September 19, 2011

Last Update: June 29, 2018

Sole Proprietor: No

Update or Correct Profile

Mailing Address

Po Box 63185

Charlotte, NC 282633001

Phone: 7066507546

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

⚠️ Medical Disclaimer

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