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ADVANCED DERMATOLOGY OF GEORGIA, LLC
NPI 1184005068
Dermatology in Albany, GA

Active since June 16, 2015CLIA Certified · 3 labs
401 W 4TH AVE, ALBANY, GA 31701(229) 883-1130(229) 883-1153 Get Directions Write a Review

NPPES record last updated: January 22, 2018. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Advanced Dermatology Of Georgia, Llc NPPES

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

ADVANCED DERMATOLOGY OF GEORGIA, LLC (NPI 1184005068) is a healthcare organization registered as a dermatology in Albany, Georgia and active in the NPI registry since June 2015. The organization holds 3 active CLIA laboratory certificates and lists Amy Declue, Director Of Provider Services, as its authorized official.

NPPES Registry Identity

NPI1184005068
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameADVANCED DERMATOLOGY OF GEORGIA, LLC
Location Address401 W 4TH AVEAlbany, GA 31701-1915
Mailing Address151 Southhall Ln, Suite 300Maitland, FL 32751-7176 · (407) 875-2080 · Fax (407) 650-3455
Phone(229) 883-1130
Fax(229) 883-1153
Organization SubpartNo
Authorized OfficialAmy DeclueDirector Of Provider Services · (407) 875-2080
Enumeration DateJune 16, 2015
Last NPPES UpdateJanuary 22, 2018
✔ NPI 1184005068 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
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.
401 W 4TH AVE, Albany, GA 31701
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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 Ambetter from Absolute Total Care, Ambetter Health, Ambetter of Alabama and more.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)

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

Clinicians Billing Medicare Through This Organization

11

Medicare enrollment records show 11 clinicians reassign Medicare billing to Advanced Dermatology Of Georgia, LLC, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.

Clinicians by Medicare Specialty 3

Dermatology9
Micrographic Dermatologic Surgery (MDS)1
Nurse Practitioner1

Clinicians, nearest first (11)

Kristen Cook, MSN, APRN, FNP-C
Nurse Practitioner
NPI 1972156057
2303 DAWSON RD STE 101
Albany, GA 31707
(229) 883-1130
✔ PECOS✔ Accepts Medicare3.0 mi
Osama Hashmi
Dermatology
NPI 1700345030
49 JESSE HILL JR DR SE
Atlanta, GA 30303
(404) 778-7777
✔ PECOS150 mi
Firas Hougeir, M.D.
Dermatology
NPI 1023095957
4645 TIMBER RIDGE DR STE 100
Douglasville, GA 30135
(678) 702-3376
✔ PECOS✔ Accepts Medicare151 mi
Jing Gill, MD
Dermatology
NPI 1164531166
771 OLD NORCROSS RD SUITE 260
Lawrenceville, GA 30046
(770) 962-5040
✔ PECOS✔ Accepts Medicare163 mi
Charya Goldsmith, M.D.
Dermatology
NPI 1164742425
771 OLD NORCROSS RD STE 260
Lawrenceville, GA 30046
(770) 962-5040
✔ PECOS✔ Accepts Medicare163 mi
Jodi Langer, M.D.
Dermatology
NPI 1639325194
771 OLD NORCROSS RD SUITE 260
Lawrenceville, GA 30046
(770) 962-5040
✔ PECOS✔ Accepts Medicare163 mi
Kenyatta Mireku, MD
Dermatology
NPI 1740600048
771 OLD NORCROSS RD STE 260
Lawrenceville, GA 30046
(770) 962-5040
✔ PECOS✔ Accepts Medicare163 mi
Kehinde Olumesi, M.D.
Dermatology
NPI 1780062661
771 OLD NORCROSS RD STE 260
Lawrenceville, GA 30046
(770) 962-5040
✔ PECOS✔ Accepts Medicare163 mi
Melinda Greenfield, DO
Dermatology
NPI 1841285723
520 A1A N STE 203
Ponte Vedra, FL 32082
(904) 567-3291
✔ PECOS✔ Accepts Medicare190 mi
David Roffwarg, M.D.
Dermatology
NPI 1063736833
107 GLIDEPATH WAY
Lebanon, TN 37090
(615) 449-5771
✔ PECOS✔ Accepts Medicare340 mi
William Chow, D.O.
Micrographic Dermatologic Surgery (MDS)
NPI 1417981192
3120 WEBSTER ST
Oakland, CA 94609
(510) 681-8587
✔ PECOS✔ Accepts Medicare2,196 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 3

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 Compliance 39D2135677

Advanced Dermatology Of Pennsylvania · Pittsburgh, PA
Active · expires Jul 16, 2028
CLIA Number39D2135677
Laboratory TypePhysician Office
Certificate Effective DateJuly 17, 2026
Certificate Expiration DateJuly 16, 2028
Laboratory DirectorDr. Sebastian S. Demarco
Laboratory Phone(407) 875-2080
Laboratory LocationAdvanced Dermatology Of Pennsylvania107 Gamma Drive, Ste 120, Pittsburgh, PA 15238
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate of Waiver 39D2134679

Advanced Dermatology Of PA - Hazelton · Hazleton, PA
Active · expires Aug 7, 2027
CLIA Number39D2134679
Laboratory TypePhysician Office
Certificate Effective DateAugust 8, 2025
Certificate Expiration DateAugust 7, 2027
Laboratory DirectorDr. Harold J. Milstein
Laboratory Phone(407) 875-2080
Laboratory LocationAdvanced Dermatology Of PA - Hazelton631 Airport Road Ste 100, Hazleton, PA 18202
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 39D2014121

Advanced Dermatology Of Pennsylvania · North Wales, PA
Active · expires Apr 1, 2027
CLIA Number39D2014121
Laboratory TypePhysician Office
Certificate Effective DateApril 2, 2025
Certificate Expiration DateApril 1, 2027
Laboratory DirectorDr. Laurel R. Schwartz
Laboratory Phone(407) 875-2080
Laboratory LocationAdvanced Dermatology Of Pennsylvania1010 Horsham Road, Suite 201, North Wales, PA 19454
CLIA data matches this NPI record on: 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 Advanced Dermatology Of Georgia, LLC's NPI number?

The NPI number for Advanced Dermatology Of Georgia, LLC is 1184005068. It was assigned to this organization in the NPPES registry on June 16, 2015.

Where is Advanced Dermatology Of Georgia, LLC located?

Advanced Dermatology Of Georgia, LLC is located at 401 W 4th Ave, Albany, GA 31701. The listed phone number is (229) 883-1130.

What is Advanced Dermatology Of Georgia, LLC's specialty?

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

Is Advanced Dermatology Of Georgia, LLC enrolled in Medicare?

Yes. Advanced Dermatology Of Georgia, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Advanced Dermatology Of Georgia, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 11 clinicians in 3 Medicare specialties reassign their Medicare billing to Advanced Dermatology Of Georgia, 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. The largest specialties are Dermatology (9), Micrographic Dermatologic Surgery (MDS) (1) and Nurse Practitioner (1). Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Advanced Dermatology Of Georgia, LLC hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Advanced Dermatology Of Georgia, LLC accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Advanced Dermatology Of Georgia, 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 Advanced Dermatology Of Georgia, LLC was last updated on January 22, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.