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MARIETTA DERMATOLOGY ASSOCIATES PA
NPI 1417007212
Dermatology in Marietta, GA

Active since January 12, 2007CLIA Certified · 2 labs
111 MARBLE MILL RD NW, MARIETTA DERMATOLOGY ASSOCIATES PA, MARIETTA, GA 30060(770) 422-1013(770) 514-5996 Get Directions Write a Review

NPPES record last updated: April 28, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Marietta Dermatology Associates Pa NPPES

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

MARIETTA DERMATOLOGY ASSOCIATES PA (NPI 1417007212) is a healthcare organization registered as a dermatology in Marietta, Georgia and active in the NPI registry since January 2007. The organization holds 2 active CLIA laboratory certificates and lists Gobin Coppa, Director Of Billing Office, as its authorized official.

NPPES Registry Identity

NPI1417007212
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameMARIETTA DERMATOLOGY ASSOCIATES PA
Location Address111 MARBLE MILL RD NW, MARIETTA DERMATOLOGY ASSOCIATES PAMarietta, GA 30060-1047
Mailing Address111 Marble Mill Rd Nw, Marietta Dermatology Associates PaMarietta, GA 30060-1047 · (770) 422-1013 · Fax (770) 514-5996
Phone(770) 422-1013
Fax(770) 514-5996
Organization SubpartNo
Authorized OfficialGobin CoppaDirector Of Billing Office · (770) 422-1013
Enumeration DateJanuary 12, 2007
Last NPPES UpdateApril 28, 2023
NPPES CertifiedApril 28, 2023
✔ NPI 1417007212 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.
111 MARBLE MILL RD NW, Marietta, GA 30060
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Other Identifiers 1

OtherCM6753Medicare Railroad

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 Mending Health.Insurance ›

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 for Provider-Performed Microscopy Procedures (PPMP) 11D0943797

Marietta Dermatology Associates PA · Canton, GA
Active · expires Apr 2, 2028
CLIA Number11D0943797
Laboratory TypePhysician Office
Certificate Effective DateApril 3, 2026
Certificate Expiration DateApril 2, 2028
Laboratory DirectorDr. Raman Piyush
Laboratory Phone(770) 422-1013
Laboratory LocationMarietta Dermatology Associates PA130 Oakside Court, Suite A, Canton, GA 30114
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 for Provider-Performed Microscopy Procedures (PPMP) 11D0943798

Marietta Dermatology Associates PA · Powder Springs, GA
Active · expires Apr 2, 2028
CLIA Number11D0943798
Laboratory TypePhysician Office
Certificate Effective DateApril 3, 2026
Certificate Expiration DateApril 2, 2028
Laboratory DirectorElizabeth Richwine
Laboratory Phone(770) 422-1013
Laboratory LocationMarietta Dermatology Associates PA5041 Dallas Hwy Ste D, Powder Springs, GA 30127
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.

Other Providers at the Same Location NPPES 18

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NICOLE BLACK PA-C
Physician Assistant
111 MARBLE MILL RD NW
MARIETTA, GA 30060
Cobb County (770) 422-1013
KELLY A HOUMAND P.A.-C
Physician Assistant (Medical)
111 MARBLE MILL RD NW
MARIETTA, GA 30060
Cobb County (770) 422-1013
LISA W HILL PA-C
Physician Assistant
111 MARBLE MILL RD NW
MARIETTA, GA 30060
Cobb County (770) 422-1013
PATRICIA ANNE FLYNN PAC
Physician Assistant
111 MARBLE MILL RD NW
MARIETTA, GA 30060
Cobb County (770) 422-1013
AMY KAY GOODMAN PA-C
Physician Assistant
111 MARBLE MILL RD NW
MARIETTA, GA 30060
Cobb County (770) 422-1013
JENNIFER ROSE LIECHTY NP
Nurse Practitioner (Family)
111 MARBLE MILL RD NW
MARIETTA, GA 30060
Cobb County (770) 425-7575
REAGAN BROOKE MORGAN PA-C
Dermatology
111 MARBLE MILL RD NW
MARIETTA, GA 30060
Cobb County (770) 422-1013
SARA KAPLAN PA-C
Physician Assistant (Medical)
111 MARBLE MILL RD NW
MARIETTA, GA 30060
Cobb County (770) 422-1013

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 Marietta Dermatology Associates PA's NPI number?

The NPI number for Marietta Dermatology Associates PA is 1417007212. It was assigned to this organization in the NPPES registry on January 12, 2007.

Where is Marietta Dermatology Associates PA located?

Marietta Dermatology Associates PA is located at 111 Marble Mill Rd NW Marietta Dermatology Associates PA, Marietta, GA 30060. The listed phone number is (770) 422-1013.

What is Marietta Dermatology Associates PA's specialty?

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

Does Marietta Dermatology Associates PA 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 Marietta Dermatology Associates PA accept?

Health plans from Mending Health list Marietta Dermatology Associates PA 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 Marietta Dermatology Associates PA was last updated on April 28, 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.