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THACKER DERMATOLOGY LLC
NPI 1326347238
Dermatology in Valdosta, GA

Active since March 17, 2011CLIA 11D2022318 · Microscopy
4233 CAMELOT CROSSING, VALDOSTA, GA 31602(229) 469-4383(229) 469-4584 Get Directions Write a Review

NPPES record last updated: October 26, 2023. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Thacker Dermatology Llc NPPES

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

THACKER DERMATOLOGY LLC (NPI 1326347238) is a healthcare organization registered as a dermatology in Valdosta, Georgia and active in the NPI registry since March 2011. The organization holds a CLIA Microscopy certificate valid through October 11, 2028 and lists Betsy Perry Thacker, Owner, as its authorized official.

NPPES Registry Identity

NPI1326347238
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameTHACKER DERMATOLOGY LLC
Location Address4233 CAMELOT CROSSINGValdosta, GA 31602
Mailing Address4233 Camelot CrossingValdosta, GA 31602 · (229) 469-4383 · Fax (229) 469-4584
Phone(229) 469-4383
Fax(229) 469-4584
Organization SubpartNo
Authorized OfficialBetsy Perry ThackerOwner · (229) 469-4383
Enumeration DateMarch 17, 2011
Last NPPES UpdateOctober 26, 2023
NPPES CertifiedOctober 26, 2023
✔ NPI 1326347238 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.
4233 CAMELOT CROSSING, Valdosta, GA 31602
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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

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

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

Clinicians Billing Medicare Through This Organization

7

Medicare enrollment records show 7 clinicians reassign Medicare billing to Thacker Dermatology LLC, which bills Medicare for the services they deliver. Of these, 6 practice at this address and 7 within 10 miles. They are listed nearest first.

Clinicians, nearest first (7)

Betsy Backe, M.D.
Dermatology
NPI 1457554131
4233 CAMELOT CROSSING
Valdosta, GA 31602
(229) 469-4383
✔ PECOS✔ Accepts MedicareSame address
Candis Davis, RN
Nurse Practitioner
NPI 1679987804
4233 CAMELOT CROSSING
Valdosta, GA 31602
(229) 469-4383
✔ PECOS✔ Accepts MedicareSame address
Nina Keown, FNP
Nurse Practitioner
NPI 1316299662
4233 CAMELOT CROSSING
Valdosta, GA 31602
(229) 469-4383
✔ PECOS✔ Accepts MedicareSame address
Abbey Vandermeid, NP
Nurse Practitioner
NPI 1801131859
4233 CAMELOT CROSSING
Valdosta, GA 31602
(229) 469-4383
✔ PECOS✔ Accepts MedicareSame address
Heidi Gonzalez, FNP-C
Nurse Practitioner
NPI 1962393744
4233 CAMELOT XING
Valdosta, GA 31602
(229) 469-4383
✔ PECOSSame address
Faith Jones, AGNP-C
Nurse Practitioner
NPI 1952182784
4233 CAMELOT CROSSING
Valdosta, GA 31602
(229) 469-4383
✔ PECOS✔ Accepts MedicareSame address
Barbara Lane, NP
Nurse Practitioner
NPI 1003699240
3541 N CROSSING CIR
Valdosta, GA 31602
(229) 244-4200
✔ PECOS✔ Accepts Medicare1.8 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 for Provider-Performed Microscopy Procedures (PPMP) 11D2022318

Thacker Dermatology, LLC · Valdosta, GA
Active · expires Oct 11, 2028
CLIA Number11D2022318
Laboratory TypePhysician Office
Certificate Effective DateOctober 12, 2026
Certificate Expiration DateOctober 11, 2028
Laboratory DirectorBetsy P. Backe
Laboratory Phone(229) 469-4383
Laboratory LocationThacker Dermatology, LLC4233 Camelot Crossing, Valdosta, GA 31602
CLIA data matches this NPI record on: Address 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 Thacker Dermatology LLC's NPI number?

The NPI number for Thacker Dermatology LLC is 1326347238. It was assigned to this organization in the NPPES registry on March 17, 2011.

Where is Thacker Dermatology LLC located?

Thacker Dermatology LLC is located at 4233 Camelot Crossing, Valdosta, GA 31602. The listed phone number is (229) 469-4383.

What is Thacker Dermatology LLC's specialty?

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

Is Thacker Dermatology LLC enrolled in Medicare?

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

How many clinicians bill Medicare through Thacker Dermatology LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 7 clinicians in 2 Medicare specialties reassign their Medicare billing to Thacker Dermatology 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 Nurse Practitioner (6) and Dermatology (1). Of these, 6 practice at this address and 7 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Thacker Dermatology LLC hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 11D2022318) is associated with this NPI, valid through October 11, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Thacker Dermatology LLC was last updated on October 26, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.