GEORGIA MOUNTAIN DERMATOLOGY, LLC
NPI 1043400088
Dermatology in Jasper, GA
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 holds a CLIA Microscopy certificate valid through July 31, 2028 and lists Carlton Trent Faulk, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Georgia Mountain Dermatology, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by January 31, 2027
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Georgia Mountain Dermatology, LLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.
Clinicians, nearest first (2)
Jasper, GA 30143
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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, GAFrequently 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.
Is Georgia Mountain Dermatology, LLC enrolled in Medicare?
Yes. Georgia Mountain Dermatology, LLC is registered in the Medicare PECOS enrollment system.
When is Georgia Mountain Dermatology, LLC's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Georgia, Clinic/Group Practice) is due for revalidation by January 31, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Georgia Mountain Dermatology, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Dermatology, reassign their Medicare billing to Georgia Mountain Dermatology, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Georgia Mountain Dermatology, LLC hold a CLIA laboratory certificate?
Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 11D1074084) is associated with this NPI, valid through July 31, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
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 weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Georgia Mountain Dermatology, Llc · NPI 1043400088
Dermatology organization in Jasper, Georgia. Organization record, active in the CMS NPPES registry since July 26, 2007.
## Identity
- **NPI:** 1043400088 (Entity type: Organization)
- **Enumerated:** July 26, 2007
- **Primary specialty:** Dermatology · taxonomy 207N00000X
- **Organization subpart:** No
- **Authorized official:** Carlton Faulk, PRESIDENT
## Practice location
- **Address:** 150 INTERSTATE SOUTH DRIVE, SUITE 100, Jasper, GA 30143
- **Phone:** (706) 253-3376
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** January 31, 2027 (Non-DME Part B, Georgia, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 2 clinicians (Dermatology) reassign Medicare billing to this organization (form CMS-855R); 1 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 26, 2007
- **Other identifiers:** Medicare UPIN F55640 (GA)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1043400088) · Data from the CMS NPPES public registry.