Active NPI 1912198979 Individual Practitioner Male Practitioner

Dr. Jonathan David Pewitt , MD

Dermatology • Marietta, GA

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Jonathan Pewitt, MD is a certified Dermatology practicing in Marietta, GA. With approximately 19 years of clinical experience since graduating from East Tennessee State University Quillen College Of Medicine in 2007, Dr. Pewitt delivers high-quality medical care to the local community at 835 COGBURN AVENUE.

Dr. Pewitt is affiliated with Aqua Dermatology Of Georgia Pc and accepts Medicare assignment.

Frequently performed procedures and clinical services include destruction of precancer skin growth, 2-14 growths, destruction of skin growth, established 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

835 Cogburn Avenue
Suite 100

Marietta, GA 300601008

Telephone 7704225557

Fax 7704225456

Associated Practice Facility / Clinic

🏢 Aqua Dermatology Of Georgia Pc Facility NPI 1114022167

Medicare Profile & Education

Medical School

East Tennessee State University Quillen College Of Medicine

Graduation Year

2007

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Dermatology in Marietta, GA

Established Specialist (10-20 Yrs)

Practitioner Clinical Experience

19 Yrs -0.4 yrs vs City Avg

City Avg: 19.4 Yrs

State Avg: 24.5 Yrs

Regional Practice Density

25 Specialists

Practicing in Marietta, GA (364 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

69.8% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Pewitt (19 Years) 19 Yrs

Marietta Specialty Average (19.4 Years) 19.4 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	843	153	$19.97	$5.96
17000 Destruction of skin growth	226	197	$200.48	$45.09
99213 Established patient office or other outpatient visit, typically 15 minutes	214	181	$269.96	$84.97
17110 Destruction of up to 14 skin growths	166	148	$338.00	$100.62
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	143	114	$378.47	$121.11
11102 Tangential biopsy of single skin lesion	131	123	$297.04	$80.24
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	107	107	$331.00	$104.05
17004 Destruction of precancer skin growth, 15 or more growths	61	44	$496.00	$153.92
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	52	48	$167.99	$52.75
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	51	51	$496.00	$158.27
11103 Biopsy of related skin growth, each additional growth	42	32	$148.99	$45.93
99202 New patient office or other outpatient visit, typically 20 minutes	21	21	$214.00	$66.04
11104 Punch biopsy, first skin growth	18	18	$370.00	$112.86
69100 Biopsy of ear	12	12	$283.00	$69.50
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	11	11	$1392.00	$430.74

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,136	192	$33.98	$6.75
17000 Destruction of skin growth	277	236	$178.88	$48.38
99213 Established patient office or other outpatient visit, typically 15 minutes	230	201	$198.92	$90.37
17110 Destruction of up to 14 skin growths	196	184	$310.19	$108.98
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	182	149	$288.87	$128.00
11102 Tangential biopsy of single skin lesion	141	132	$226.48	$92.03
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	131	131	$235.40	$111.70
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	67	67	$358.13	$166.94
87220 Tissue fungi or parasites	57	48	$28.42	$4.18
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	48	45	$126.85	$56.73
11103 Biopsy of related skin growth, each additional growth	44	32	$118.18	$49.94
17004 Destruction of precancer skin growth, 15 or more growths	39	35	$405.28	$171.12
99202 New patient office or other outpatient visit, typically 20 minutes	35	35	$158.37	$72.62
11104 Punch biopsy, first skin growth	25	24	$291.00	$127.59
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	20	13	$260.50	$69.51
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	17	17	$317.59	$109.33
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	16	16	$478.38	$163.95
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	13	13	$1300.85	$477.99

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,064	357	$40.00	$6.15
17000 Destruction of skin growth	569	468	$150.00	$49.56
99213 Established patient office or other outpatient visit, typically 15 minutes	528	473	$105.00	$84.81
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	352	281	$155.00	$120.88
17110 Destruction of up to 14 skin growths	340	303	$210.00	$102.49
11102 Tangential biopsy of single skin lesion	187	172	$305.00	$83.30
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	166	150	$65.00	$53.11
17004 Destruction of precancer skin growth, 15 or more growths	65	53	$400.00	$156.52
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	61	61	$155.00	$102.79
11103 Biopsy of related skin growth, each additional growth	55	35	$165.00	$47.67
36415 Insertion of needle into vein for collection of blood sample	45	35	$15.00	$2.96
99202 New patient office or other outpatient visit, typically 20 minutes	43	43	$110.00	$67.14
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	35	31	$1255.00	$411.91
11104 Punch biopsy, first skin growth	32	31	$385.00	$107.08
87210 Smear for infectious agents	32	31	$30.00	$5.71
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	23	11	$16.00	$1.15
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	22	22	$1130.00	$398.73
Q0112 All potassium hydroxide (koh) preparations	21	19	$35.00	$5.80
80053 Blood test, comprehensive group of blood chemicals	19	13	$60.00	$10.42
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	17	15	$400.00	$142.54
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	17	13	$40.00	$7.64
11622 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	17	17	$470.00	$125.44
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	16	16	$240.00	$159.19
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	14	13	$490.00	$135.37
80076 Liver function blood test panel	14	11	$50.00	$8.08
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	12	12	$450.00	$120.35

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,107	388	$40.00	$5.94
17000 Destruction of skin growth	618	498	$150.00	$47.94
99213 Established patient office or other outpatient visit, typically 15 minutes	574	492	$105.00	$85.94
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	348	263	$153.51	$121.98
17110 Destruction of up to 14 skin growths	311	279	$210.00	$103.04
11102 Tangential biopsy of single skin lesion	252	226	$305.00	$83.81
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	188	168	$65.00	$52.89
11103 Biopsy of related skin growth, each additional growth	72	50	$165.00	$48.69
99202 New patient office or other outpatient visit, typically 20 minutes	71	71	$107.32	$67.93
17004 Destruction of precancer skin growth, 15 or more growths	69	57	$400.00	$155.02
36415 Insertion of needle into vein for collection of blood sample	57	42	$15.00	$2.95
Q0112 All potassium hydroxide (koh) preparations	54	52	$35.00	$5.83
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	31	26	$374.19	$153.86
80053 Blood test, comprehensive group of blood chemicals	29	16	$60.00	$10.56
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	26	15	$26.92	$7.77
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	25	25	$155.00	$101.94
11104 Punch biopsy, first skin growth	24	24	$385.00	$106.37
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	23	22	$1255.00	$454.71
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	20	18	$401.00	$150.42
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	19	18	$490.00	$128.22
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	11	11	$800.00	$371.73

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,983	378	$40.00	$5.59
99213 Established patient office or other outpatient visit, typically 15 minutes	660	532	$105.00	$71.48
17000 Destruction of skin growth	594	483	$150.00	$49.43
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	333	250	$150.02	$102.94
17110 Destruction of up to 14 skin growths	307	277	$210.00	$103.79
11102 Tangential biopsy of single skin lesion	262	237	$305.00	$83.64
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	249	212	$65.00	$43.25
17004 Destruction of precancer skin growth, 15 or more growths	95	65	$400.00	$150.65
Q0112 All potassium hydroxide (koh) preparations	79	73	$35.00	$5.64
99202 New patient office or other outpatient visit, typically 20 minutes	78	78	$105.00	$71.27
11103 Biopsy of related skin growth, each additional growth	74	53	$165.00	$49.87
36415 Insertion of needle into vein for collection of blood sample	70	53	$15.00	$2.79
11104 Punch biopsy, first skin growth	47	45	$385.00	$109.41
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	40	34	$320.00	$141.93
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	31	29	$1255.00	$459.09
99201 New patient office or other outpatient visit, typically 10 minutes	29	29	$65.00	$39.30
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	27	23	$490.00	$139.69
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	25	16	$40.00	$6.83
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	25	19	$350.00	$162.64
80053 Blood test, comprehensive group of blood chemicals	24	18	$60.00	$9.31
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	22	21	$800.00	$403.27
80076 Liver function blood test panel	18	13	$50.00	$8.12
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	17	12	$16.00	$1.47
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	16	16	$155.00	$104.09
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	12	12	$450.00	$118.71

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,535	450	$40.00	$5.29
17000 Destruction of skin growth	723	570	$150.00	$48.96
99213 Established patient office or other outpatient visit, typically 15 minutes	704	579	$105.00	$70.49
17110 Destruction of up to 14 skin growths	377	326	$210.00	$100.36
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	327	272	$65.00	$42.71
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	324	235	$150.00	$102.38
11102 Tangential biopsy of single skin lesion	279	246	$300.23	$83.56
99202 New patient office or other outpatient visit, typically 20 minutes	101	101	$105.00	$73.40
17004 Destruction of precancer skin growth, 15 or more growths	87	68	$400.00	$143.60
36415 Insertion of needle into vein for collection of blood sample	80	59	$15.00	$2.80
Q0112 All potassium hydroxide (koh) preparations	78	73	$35.00	$5.39
11103 Biopsy of related skin growth, each additional growth	61	50	$163.28	$50.55
11104 Punch biopsy, first skin growth	53	53	$380.38	$117.62
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	39	26	$40.00	$7.66
80053 Blood test, comprehensive group of blood chemicals	38	26	$60.00	$10.83
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	38	34	$1255.00	$463.23
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	30	28	$320.00	$146.60
99201 New patient office or other outpatient visit, typically 10 minutes	29	29	$65.00	$40.53
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	27	27	$800.00	$401.29
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	25	25	$490.00	$136.09
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	17	16	$350.00	$168.98
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	17	13	$16.00	$1.58
80076 Liver function blood test panel	16	12	$50.00	$8.90
11622 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	15	15	$470.00	$123.24
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	15	14	$450.00	$119.42
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	15	15	$155.00	$104.79
11643 Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips	12	11	$585.00	$154.94
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	12	11	$650.00	$255.02
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	11	11	$340.00	$164.30

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,206	389	$40.00	$4.91
99213 Established patient office or other outpatient visit, typically 15 minutes	709	572	$105.00	$68.82
17000 Destruction of skin growth	633	512	$150.00	$48.56
17110 Destruction of up to 14 skin growths	394	327	$210.00	$100.63
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	374	276	$150.00	$101.96
11100 Biopsy of single growth of skin and/or tissue	356	318	$210.00	$85.80
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	227	211	$65.00	$40.66
99202 New patient office or other outpatient visit, typically 20 minutes	118	118	$105.00	$69.94
36415 Insertion of needle into vein for collection of blood sample	100	67	$15.00	$2.91
11101 Biopsy of each additional growth of skin and/or tissue	95	69	$100.00	$30.90
17004 Destruction of precancer skin growth, 15 or more growths	92	70	$400.00	$135.31
Q0112 All potassium hydroxide (koh) preparations	79	74	$35.00	$5.66
99201 New patient office or other outpatient visit, typically 10 minutes	48	48	$65.00	$41.50
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	42	27	$40.00	$9.40
80053 Blood test, comprehensive group of blood chemicals	38	23	$60.00	$12.78
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	36	32	$1255.00	$445.81
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	33	26	$320.00	$121.04
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	29	28	$490.00	$130.64
80076 Liver function blood test panel	29	18	$50.00	$9.89
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	28	28	$156.79	$98.69
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	23	23	$800.00	$404.83
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	22	21	$350.00	$167.52
17272 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	19	18	$340.00	$154.56
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	12	12	$450.00	$127.53
11900 Injection into skin growth, 1-7 growths	12	11	$140.00	$39.98

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,442	392	$40.00	$5.13
99213 Established patient office or other outpatient visit, typically 15 minutes	906	712	$105.00	$68.31
17000 Destruction of skin growth	661	518	$150.00	$48.64
17110 Destruction of up to 14 skin growths	373	317	$210.00	$97.99
11100 Biopsy of single growth of skin and/or tissue	339	301	$210.00	$86.92
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	332	221	$150.00	$101.07
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	222	193	$65.00	$40.27
17004 Destruction of precancer skin growth, 15 or more growths	130	103	$400.00	$139.07
99202 New patient office or other outpatient visit, typically 20 minutes	114	114	$106.18	$66.50
36415 Insertion of needle into vein for collection of blood sample	99	70	$15.00	$2.82
11101 Biopsy of each additional growth of skin and/or tissue	98	73	$100.00	$31.19
Q0112 All potassium hydroxide (koh) preparations	87	76	$35.00	$5.48
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	48	32	$40.00	$10.23
80053 Blood test, comprehensive group of blood chemicals	40	28	$60.00	$13.85
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	39	39	$156.28	$98.55
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	35	33	$1087.86	$448.93
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	28	28	$490.00	$127.87
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	24	21	$320.00	$141.28
80076 Liver function blood test panel	24	16	$50.00	$10.93
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	22	16	$16.00	$1.80
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	21	21	$800.00	$401.56
17263 Destruction of cancer skin growth of trunk, arms, or legs, 2.1-3.0 cm	20	18	$350.00	$166.09
11900 Injection into skin growth, 1-7 growths	20	16	$140.00	$47.10
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	18	12	$48.00	$23.54
99201 New patient office or other outpatient visit, typically 10 minutes	16	16	$65.00	$36.19
11643 Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips	15	15	$585.00	$151.41
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	13	11	$580.77	$283.77
82728 Ferritin (blood protein) level	11	11	$85.00	$18.33

Medical Specialties & State Licenses

CMS Verified: 2023-03-30

Dermatology Primary Specialty

NUCC Taxonomy Code: 207N00000X

State License GA 065413

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.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID

003108826A (GU)

Hospital & Practice Group Affiliations

Aqua Dermatology Of Georgia Pc

18 Riverbend Dr Sw, Rome, GA 301616019

Phone: 7068858336

Aqua Dermatology Of Georgia Pc

835 Cogburn Ave Nw, Marietta, GA 300601008

Phone: 7704225557

Practice Associates & Co-Workers

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

16 Associated Practitioners

Dr. Jordan Thompson , MD

Dermatology

NPI 1073049920

Doctor of Medicine (M.D.)

Dr. Jennifer Jones , MD

Dermatology

NPI 1114985108

Doctor of Medicine (M.D.)

Dr. Jennifer Buckley , MD

Dermatology

NPI 1215908652

Doctor of Medicine (M.D.)

Alice Franklin , PA-C

Physician Assistant - Medical

NPI 1346359585

Physician Assistant (Certified)

Erin Barnett , PA-C

Physician Assistant

NPI 1396817235

Physician Assistant (Certified)

Carolyn Sims , PA-C

Physician Assistant - Medical

NPI 1407957087

Physician Assistant (Certified)

Career & Practice History Timeline

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

9 Historical Events

📍

Updated Practice Location March 30, 2023

Registered at 835 COGBURN AVENUE, SUITE 100, MARIETTA, GA 300601008 (Tel: 7704225557)

📍

Updated Business Mailing Address March 30, 2023

Registered at 835 COGBURN AVENUE, SUITE 250, MARIETTA, GA 300601010 (Tel: 7704228815)

📍

Updated Business Mailing Address February 04, 2019

Registered at 221 TECHNOLOGY PKWY NW, ROME, GA 301651369 (Tel: 7622351000)

✅

NPI Profile Active January 24, 2012

NPI status registered as active in NPPES database

📍

Updated Practice Location January 24, 2012

Registered at 550 REDMOND RD NW, ROME, GA 301651416 (Tel: 7062338516)

📍

Updated Business Mailing Address January 24, 2012

Registered at 1825 MARTHA BERRY BLVD NW, ROME, GA 301651625 (Tel: 7062955331)

👤

Provider Name / Credentials Updated January 24, 2012

Recorded as JONATHAN PEWITT, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) January 24, 2012

Dermatology (License #065413 in GA)

🟢

Initial NPI Registration & Enumeration August 06, 2007

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1912198979

Entity Type:

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

Enumeration Date: August 06, 2007

Last Update: March 30, 2023

Sole Proprietor: No

Update or Correct Profile

Mailing Address

835 Cogburn Avenue, Suite 250

Marietta, GA 300601010

Phone: 7704228815

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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