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SOUTHERN DERMATOLOGY MEDICAL LLC
NPI 1265024186
Dermatology in Aiken, SC

Active since February 11, 2021CLIA 11D2237646 · Waiver
3555 RICHLAND AVE W STE 174, AIKEN, SC 29801(803) 335-0066(762) 224-2177 Get Directions Write a Review

NPPES record last updated: January 13, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Dec 27, 2024, Apr 8, 2024, Feb 11, 2021 (3 updates tracked since 2021).

About Southern Dermatology Medical Llc NPPES

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

SOUTHERN DERMATOLOGY MEDICAL LLC (NPI 1265024186) is a healthcare organization registered as a dermatology in Aiken, South Carolina and active in the NPI registry since February 2021. The organization holds a CLIA Waiver certificate valid through September 26, 2027, maintains a secondary practice location in Evans, and lists Briana Brown, Dermatologist, as its authorized official.

NPPES Registry Identity

NPI1265024186
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameSOUTHERN DERMATOLOGY MEDICAL LLC
Location Address3555 RICHLAND AVE W STE 174Aiken, SC 29801-6410
Mailing Address4158 Washington Rd Ste 9Evans, GA 30809-4720 · (706) 760-0013
Phone(803) 335-0066
Fax(762) 224-2177
Organization SubpartNo
Authorized OfficialBriana BrownDermatologist · (412) 995-0025
Enumeration DateFebruary 11, 2021
Last NPPES UpdateJanuary 13, 20253 updates tracked since enumeration
NPPES CertifiedJanuary 8, 2025
✔ NPI 1265024186 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.
3555 RICHLAND AVE W STE 174, Aiken, SC 29801
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Secondary Practice Location 1

Location 14150 Washington Rd Ste 6Evans, GA 30809-4722 · Phone (706) 760-0013

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)

Southern Dermatology Medical 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 Southern Dermatology Medical LLC, which bills Medicare for the services they deliver. They are listed nearest first.

Clinicians, nearest first (3)

Briana Brown, D.O.
Dermatology
NPI 1164835104
4150 WASHINGTON RD STE 6
Evans, GA 30809
(706) 760-0013
✔ PECOS✔ Accepts Medicare20 mi
Amy Williams, FNP
Nurse Practitioner
NPI 1215765839
4150 WASHINGTON RD STE 6
Evans, GA 30809
(478) 952-6860
✔ PECOS✔ Accepts Medicare20 mi
Kamaria Nelson, M.D.
Dermatology
NPI 1952836165
834 FARRAR DR
Conway, SC 29526
(843) 839-4142
✔ PECOS✔ Accepts Medicare159 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 11D2237646

Southern Dermatology Medical LLC · Evans, GA
Active · expires Sep 26, 2027
CLIA Number11D2237646
Laboratory TypePhysician Office
Certificate Effective DateSeptember 27, 2025
Certificate Expiration DateSeptember 26, 2027
Laboratory DirectorBriana Brown
Laboratory Phone(706) 760-0013
Laboratory LocationSouthern Dermatology Medical LLC4150 Washington Road Suite 6, Evans, GA 30809
CLIA data matches this NPI record on: Address 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 Southern Dermatology Medical LLC's NPI number?

The NPI number for Southern Dermatology Medical LLC is 1265024186. It was assigned to this organization in the NPPES registry on February 11, 2021.

Where is Southern Dermatology Medical LLC located?

Southern Dermatology Medical LLC is located at 3555 Richland Ave W Ste 174, Aiken, SC 29801. The listed phone number is (803) 335-0066.

What is Southern Dermatology Medical LLC's specialty?

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

Is Southern Dermatology Medical LLC enrolled in Medicare?

Yes. Southern Dermatology Medical LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Southern Dermatology Medical LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Southern Dermatology Medical LLC, in Dermatology and Nurse Practitioner. 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 Southern Dermatology Medical LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2237646) is associated with this NPI, valid through September 26, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Southern Dermatology Medical LLC was last updated on January 13, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months 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.