GEORGIA MOUNTAIN DERMATOLOGY, LLC
NPI 1043400088
Dermatology in Jasper, GA

Active since July 26, 2007
150 INTERSTATE SOUTH DRIVE, SUITE 100, JASPER, GA 30143(706) 253-3376 Get Directions Write a Review

NPPES record last updated: July 26, 2007. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Georgia Mountain Dermatology, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GEORGIA MOUNTAIN DERMATOLOGY, LLC (NPI 1043400088) is a healthcare organization registered as a dermatology in Jasper, Georgia and active in the NPI registry since July 2007. The organization lists Carlton Trent Faulk, President, as its authorized official.

NPPES Registry Identity

NPI1043400088
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameGEORGIA MOUNTAIN DERMATOLOGY, LLC
Location Address150 INTERSTATE SOUTH DRIVE, SUITE 100Jasper, GA 30143
Mailing Address150 Interstate South Drive, Suite 100Jasper, GA 30143
Organization SubpartNo
Authorized OfficialCarlton Trent FaulkPresident · (706) 253-3376
Enumeration DateJuly 26, 2007
NPI 1043400088 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License Licensed in GA · 033322
Definition

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.

150 INTERSTATE SOUTH DRIVE, Jasper, GA 30143

Other Identifiers 1

Medicare UPINF55640GA

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 11D1074084

Georgia Mountain Dermatology, LLC · Jasper, GA
Expired · Jul 31, 2026
CLIA Number11D1074084
Laboratory TypePhysician Office
Certificate Effective DateAugust 1, 2024
Certificate Expiration DateJuly 31, 2026
Laboratory DirectorSr. Carlton T. Faulk
Laboratory Phone(706) 253-3376
Laboratory LocationGeorgia Mountain Dermatology, LLC150 Interstate South Drive Suite 100, Jasper, GA 30143
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Georgia Mountain Dermatology, LLC's NPI number?

The NPI number for Georgia Mountain Dermatology, LLC is 1043400088. It was assigned to this organization in the NPPES registry on July 26, 2007.

Where is Georgia Mountain Dermatology, LLC located?

Georgia Mountain Dermatology, LLC is located at 150 Interstate South Drive Suite 100, Jasper, GA 30143. The listed phone number is (706) 253-3376.

What is Georgia Mountain Dermatology, LLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

When was this NPI record last updated?

The NPPES record for Georgia Mountain Dermatology, LLC was last updated on July 26, 2007. NPI Profile syncs with the weekly NPPES data releases published by CMS.