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EVANS DERMATOLOGY, LLC
NPI 1083862577
Specialist in Evans, GA

Active since September 09, 2008CLIA 11D2041542 · Waiver
902 PONDER PLACE CT, EVANS, GA 30809(706) 922-3376(706) 922-5643 Get Directions Write a Review

NPPES record last updated: November 7, 2008. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Evans Dermatology, Llc NPPES

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

EVANS DERMATOLOGY, LLC (NPI 1083862577) is a healthcare organization registered as a specialist in Evans, Georgia and active in the NPI registry since September 2008. The organization holds a CLIA Waiver certificate valid through May 23, 2028 and lists Frances Florentino, Member, as its authorized official.

NPPES Registry Identity

NPI1083862577
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameEVANS DERMATOLOGY, LLC
Location Address902 PONDER PLACE CTEvans, GA 30809-3184
Mailing Address902 Ponder Place CtEvans, GA 30809-3184 · (706) 922-3376 · Fax (706) 922-5643
Phone(706) 922-3376
Fax(706) 922-5643
Organization SubpartNo
Authorized OfficialFrances FlorentinoMember · (407) 595-4859
Enumeration DateSeptember 9, 2008
Last NPPES UpdateNovember 7, 2008
✔ NPI 1083862577 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in GA · 0576116
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
902 PONDER PLACE CT, Evans, GA 30809
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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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BlueCross BlueShield of South Carolina.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Evans Dermatology, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Evans Dermatology, LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Frances Florentino, MD
Dermatology
NPI 1255421475
1002 WILLIAMSBURG WAY
Evans, GA 30809
(706) 922-3376
✔ PECOS✔ Accepts Medicare1.3 mi

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 of Waiver 11D2041542

Evans Dermatology, LLC · Evans, GA
Active · expires May 23, 2028
CLIA Number11D2041542
Laboratory TypePhysician Office
Certificate Effective DateMay 24, 2026
Certificate Expiration DateMay 23, 2028
Laboratory DirectorFrances T. Florentino
Laboratory Phone(706) 922-3376
Laboratory LocationEvans Dermatology, LLC1002 Williamsburg Way, Evans, GA 30809
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only 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 Evans Dermatology, LLC's NPI number?

The NPI number for Evans Dermatology, LLC is 1083862577. It was assigned to this organization in the NPPES registry on September 9, 2008.

Where is Evans Dermatology, LLC located?

Evans Dermatology, LLC is located at 902 Ponder Place Ct, Evans, GA 30809. The listed phone number is (706) 922-3376.

What is Evans Dermatology, LLC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Evans Dermatology, LLC enrolled in Medicare?

Yes. Evans Dermatology, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Evans Dermatology, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Evans 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Evans Dermatology, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2041542) is associated with this NPI, valid through May 23, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Evans Dermatology, LLC accept?

Health plans from BlueCross BlueShield of South Carolina list Evans Dermatology, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Evans Dermatology, LLC was last updated on November 7, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.