MODERN DERMATOLOGY ATLANTA
NPI 1164947115
Dermatology in Dunwoody, GA

Active since August 11, 2017
5696 WHITEHALL WALK, DUNWOODY, GA 30338(423) 280-2594 Get Directions Write a Review

NPPES record last updated: August 11, 2017. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Modern Dermatology Atlanta NPPES

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

MODERN DERMATOLOGY ATLANTA (NPI 1164947115) is a healthcare organization registered as a dermatology in Dunwoody, Georgia and active in the NPI registry since August 2017. The organization lists Naga B Meduri, Owner, as its authorized official.

NPPES Registry Identity

NPI1164947115
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameMODERN DERMATOLOGY ATLANTA
Location Address5696 WHITEHALL WALKDunwoody, GA 30338
Mailing Address5696 Whitehall WalkDunwoody, GA 30338-2655
Organization SubpartNo
Authorized OfficialNaga B MeduriOwner · (423) 280-2594
Enumeration DateAugust 11, 2017
✔ NPI 1164947115 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License✔ Licensed in GA · 57104
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.
5696 WHITEHALL WALK, Dunwoody, GA 30338

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

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Modern Dermatology Atlanta 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 Modern Dermatology Atlanta, which bills Medicare for the services this clinician delivers.

Clinician (1)

Dermatology
NPI 1346344405
1400 NORTHSIDE FORSYTH DRIVE, SUITE 350 KAISER PERMANENTE FORSYTH MEDICAL CENTER
Cumming, GA 30041
(214) 265-1818
✔ PECOS✔ Accepts Medicare18 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Modern Dermatology Atlanta's NPI number?

The NPI number for Modern Dermatology Atlanta is 1164947115. It was assigned to this organization in the NPPES registry on August 11, 2017.

Where is Modern Dermatology Atlanta located?

Modern Dermatology Atlanta is located at 5696 Whitehall Walk, Dunwoody, GA 30338. The listed phone number is (423) 280-2594.

What is Modern Dermatology Atlanta's specialty?

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

Is Modern Dermatology Atlanta enrolled in Medicare?

Yes. Modern Dermatology Atlanta is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Modern Dermatology Atlanta?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Modern Dermatology Atlanta. 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.

When was this NPI record last updated?

The NPPES record for Modern Dermatology Atlanta was last updated on August 11, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.