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EPIPHANY DERMATOLOGY OF GEORGIA, LLC
NPI 1265544357
Dermatology in Fayetteville, GA

Active since August 31, 2006CLIA Certified · 5 labs
874 LANIER AVE W STE 270, FAYETTEVILLE, GA 30214(770) 251-5111 Get Directions Write a Review

NPPES record last updated: March 19, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 19, 2025, Dec 7, 2023, Feb 24, 2021 and 1 more (4 updates tracked since 2018).

About Epiphany Dermatology Of Georgia, Llc NPPES

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

EPIPHANY DERMATOLOGY OF GEORGIA, LLC (NPI 1265544357), doing business as Epiphany Dermatology, is a healthcare organization registered as a dermatology in Fayetteville, Georgia and active in the NPI registry since August 2006. The organization holds 5 active CLIA laboratory certificates and lists Gheorghe Pusta, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1265544357
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameEPIPHANY DERMATOLOGY OF GEORGIA, LLC
Location Address874 LANIER AVE W STE 270Fayetteville, GA 30214-7617
Mailing Address7300 Ranch Road 2222, Building 1, Ste 200Austin, TX 78730 · (512) 628-0465 · Fax (512) 233-2711
Phone(770) 251-5111
Organization SubpartNo
Authorized OfficialGheorghe PustaExecutive Director · (512) 628-0465
Enumeration DateAugust 31, 2006
Last NPPES UpdateMarch 19, 20254 updates tracked since enumeration
NPPES CertifiedMarch 19, 2025
✔ NPI 1265544357 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ 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.
Also ListedDermatology · MOHS-Micrographic SurgeryTaxonomy 207ND0101X
Also ListedDermatology · Procedural DermatologyTaxonomy 207NS0135X
874 LANIER AVE W STE 270, Fayetteville, GA 30214
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Other Names 1

Doing Business AsEpiphany Dermatology

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 MULTIPLE 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 ›

CLIA Laboratory Certificates CMS CLIA 5

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 11D2288458

Epiphany Dermatology Of Georgia, LLC · Atlanta, GA
Active · expires Aug 19, 2027
CLIA Number11D2288458
Laboratory TypePhysician Office
Certificate Effective DateAugust 20, 2025
Certificate Expiration DateAugust 19, 2027
Laboratory DirectorTitilola Sode
Laboratory Phone(770) 251-5111
Laboratory LocationEpiphany Dermatology Of Georgia, LLC271 Green Hill Road NE, Atlanta, GA 30342
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.

Certificate of Compliance 11D2232160

Epiphany Dermatology Of Georgia,llc · Fayetteville, GA
Active · expires Jul 13, 2027
CLIA Number11D2232160
Laboratory TypePhysician Office
Certificate Effective DateJuly 14, 2025
Certificate Expiration DateJuly 13, 2027
Laboratory DirectorKehinde R. Olumesi
Laboratory Phone(770) 251-5111
Laboratory LocationEpiphany Dermatology Of Georgia,llc874 West Lanier Avenue, Suite 270, Fayetteville, GA 30214
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.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 11D2274388

Epiphany Dermatology Of Georgia, LLC · Newnan, GA
Active · expires Jan 3, 2027
CLIA Number11D2274388
Laboratory TypePhysician Office
Certificate Effective DateJanuary 4, 2025
Certificate Expiration DateJanuary 3, 2027
Laboratory DirectorSandra Morris
Laboratory Phone(770) 251-5111
Laboratory LocationEpiphany Dermatology Of Georgia, LLC710 Newnan Crossing Bypass, Suite 300, Newnan, GA 30263
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Certificate of Compliance 11D0686950

Epiphany Dermatology Of Georgia,llc · Newnan, GA
Active · expires Oct 24, 2026
CLIA Number11D0686950
Laboratory TypePhysician Office
Certificate Effective DateOctober 25, 2024
Certificate Expiration DateOctober 24, 2026
Laboratory DirectorSteven M. Marcet
Laboratory Phone(770) 251-5111
Laboratory LocationEpiphany Dermatology Of Georgia,llc710 Newnan Crossing Bypass Suite A, Newnan, GA 30263
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.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 11D2075618

Epiphany Dermatology Of Georgia, LLC · Peachtree City, GA
Active · expires Aug 23, 2026
CLIA Number11D2075618
Laboratory TypePhysician Office
Certificate Effective DateAugust 24, 2024
Certificate Expiration DateAugust 23, 2026
Laboratory DirectorJill Buckthal-Mccuin
Laboratory Phone(770) 251-5111
Laboratory LocationEpiphany Dermatology Of Georgia, LLC1975 Hwy 54 West, Suite 250, Peachtree City, GA 30269
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform 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 Epiphany Dermatology Of Georgia, LLC's NPI number?

The NPI number for Epiphany Dermatology Of Georgia, LLC is 1265544357. It was assigned to this organization in the NPPES registry on August 31, 2006. The provider is doing business as Epiphany Dermatology.

Where is Epiphany Dermatology Of Georgia, LLC located?

Epiphany Dermatology Of Georgia, LLC is located at 874 Lanier Ave W Ste 270, Fayetteville, GA 30214. The listed phone number is (770) 251-5111.

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

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

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

Yes. 5 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 Epiphany 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 Epiphany 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 Epiphany Dermatology Of Georgia, LLC was last updated on March 19, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.