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BAUCOM & MINA DERM SURGERY, LLC
NPI 1245780980
Dermatology - MOHS-Micrographic Surgery in Atlanta, GA

Active since October 06, 2016CLIA Certified · 2 labs
5555 PEACHTREE DUNWOODY RD, SUITE 206, ATLANTA, GA 30342(404) 844-0496(404) 844-0499 Get Directions Write a Review

NPPES record last updated: December 13, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Dec 13, 2023, Dec 4, 2018 (2 updates tracked since 2018).

About Baucom & Mina Derm Surgery, Llc NPPES

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

BAUCOM & MINA DERM SURGERY, LLC (NPI 1245780980) is a healthcare organization registered as a mohs-micrographic surgery in Atlanta, Georgia and active in the NPI registry since October 2016. The organization holds 2 active CLIA laboratory certificates and lists Mary Alice Mina, Owner, as its authorized official.

NPPES Registry Identity

NPI1245780980
Entity TypeOrganization
Primary Taxonomy207ND0101X
Legal Business NameBAUCOM & MINA DERM SURGERY, LLC
Location Address5555 PEACHTREE DUNWOODY RD, SUITE 206Atlanta, GA 30342-1703
Mailing Address5555 Peachtree Dunwoody Rd, Suite 206Atlanta, GA 30342-1703
Phone(404) 844-0496
Fax(404) 844-0499
Organization SubpartNo
Authorized OfficialMary Alice MinaOwner · (404) 844-0496
Enumeration DateOctober 6, 2016
Last NPPES UpdateDecember 13, 20232 updates tracked since enumeration
NPPES CertifiedDecember 13, 2023
✔ NPI 1245780980 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatology · MOHS-Micrographic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207ND0101X
Definition
The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S.
5555 PEACHTREE DUNWOODY RD, Atlanta, GA 30342
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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)

Baucom & Mina Derm Surgery, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Baucom & Mina Derm Surgery, LLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (3)

Mark Baucom, M.D.
Dermatology
NPI 1831184357
5555 PEACHTREE DUNWOODY RD NE STE 206
Atlanta, GA 30342
(404) 844-0496
✔ PECOS✔ Accepts MedicareSame address
Mary Alice Mina, M.D.
Dermatology
NPI 1538329149
5555 PEACHTREE DUNWOODY RD SUITE 206
Atlanta, GA 30342
(404) 844-0496
✔ PECOS✔ Accepts MedicareSame address
Erin Watkins, P.A.
Dermatology
NPI 1992973556
3400 OLD MILTON PKWY STE 465
Alpharetta, GA 30005
(678) 888-4460
✔ PECOS✔ Accepts Medicare12 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 2

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 11D0906008

Baucom And Mina Derm Surgery, LLC · Atlanta, GA
Active · expires Nov 13, 2027
CLIA Number11D0906008
Laboratory TypePhysician Office
Certificate Effective DateNovember 14, 2025
Certificate Expiration DateNovember 13, 2027
Laboratory DirectorMark F. Baucom
Laboratory Phone(404) 844-0496
Laboratory LocationBaucom And Mina Derm Surgery, LLC5555 Peachtree Dunwoody Road Suite 206, Atlanta, GA 30342
CLIA data matches this NPI record on: Address 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 Compliance 11D2180746

Baucom & Mina Derm Surgery, LLC · Johns Creek, GA
Active · expires Dec 17, 2026
CLIA Number11D2180746
Laboratory TypeAmbulatory Surgery Center
Certificate Effective DateDecember 18, 2024
Certificate Expiration DateDecember 17, 2026
Laboratory DirectorMark F. Baucom
Laboratory Phone(404) 844-0496
Laboratory LocationBaucom & Mina Derm Surgery, LLC10750 Medlock Bridge Road, Suite 101, Johns Creek, GA 30097
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

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 Baucom & Mina Derm Surgery, LLC's NPI number?

The NPI number for Baucom & Mina Derm Surgery, LLC is 1245780980. It was assigned to this organization in the NPPES registry on October 6, 2016.

Where is Baucom & Mina Derm Surgery, LLC located?

Baucom & Mina Derm Surgery, LLC is located at 5555 Peachtree Dunwoody Rd Suite 206, Atlanta, GA 30342. The listed phone number is (404) 844-0496.

What is Baucom & Mina Derm Surgery, LLC's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in MOHS-Micrographic Surgery, with taxonomy code 207ND0101X.

Is Baucom & Mina Derm Surgery, LLC enrolled in Medicare?

Yes. Baucom & Mina Derm Surgery, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Baucom & Mina Derm Surgery, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians, all in Dermatology, reassign their Medicare billing to Baucom & Mina Derm Surgery, 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, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Baucom & Mina Derm Surgery, LLC hold CLIA laboratory certificates?

Yes. 2 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 Baucom & Mina Derm Surgery, LLC accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Baucom & Mina Derm Surgery, 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 Baucom & Mina Derm Surgery, LLC was last updated on December 13, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.