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NORTHWEST GEORGIA DERMATOLOGY & SKIN SURGERY CENTER PC
NPI 1467641381
Dermatology - Procedural Dermatology in Rome, GA

Active since October 16, 2007CLIA Certified · 2 labs
103 JOHN MADDOX DR NW, ROME, GA 30165(706) 235-7711(706) 235-9944 Get Directions Write a Review

NPPES record last updated: October 19, 2011. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Northwest Georgia Dermatology & Skin Surgery Center Pc NPPES

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

NORTHWEST GEORGIA DERMATOLOGY & SKIN SURGERY CENTER PC (NPI 1467641381) is a healthcare organization registered as a procedural dermatology in Rome, Georgia and active in the NPI registry since October 2007. The organization holds 2 active CLIA laboratory certificates and lists Jason L Smith, Owner/president, as its authorized official.

NPPES Registry Identity

NPI1467641381
Entity TypeOrganization
Primary Taxonomy207NS0135X
Legal Business NameNORTHWEST GEORGIA DERMATOLOGY & SKIN SURGERY CENTER PC
Location Address103 JOHN MADDOX DR NWRome, GA 30165-1419
Mailing Address103 John Maddox Dr NwRome, GA 30165-1419 · (706) 235-7711 · Fax (706) 235-9944
Phone(706) 235-7711
Fax(706) 235-9944
Organization SubpartNo
Authorized OfficialJason L SmithOwner/president · (706) 235-7711
Enumeration DateOctober 16, 2007
Last NPPES UpdateOctober 19, 2011
✔ NPI 1467641381 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatology · Procedural DermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207NS0135X
License✔ Licensed in GA · 032302
Definition
Procedural Dermatology, a subspecialty of Dermatology, encompassing a wide variety of surgical procedures and methods to remove or modify skin tissue for health or cosmetic benefit. These methods include scalpel surgery, laser surgery, chemical surgery, cryosurgery (liquid nitrogen), electrosurgery, aspiration surgery, liposuction, injection of filler substances, and Mohs micrographic controlled surgery (a special technique for the removal of growths, especially skin cancers).
103 JOHN MADDOX DR NW, Rome, GA 30165
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Other Identifiers 3

Medicare UPINB61951GA
Medicare PINGRP4051GA
Medicaid000398384AGA

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 Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter Health 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)

Northwest Georgia Dermatology & Skin Surgery Center Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

5

Medicare enrollment records show 5 clinicians reassign Medicare billing to Northwest Georgia Dermatology & Skin Surgery Center PC, which bills Medicare for the services they deliver. Of these, 4 practice at this address. They are listed nearest first.

Clinicians, nearest first (5)

Tricia Collins, DCNP
Nurse Practitioner
NPI 1265812879
103 JOHN MADDOX DR NW
Rome, GA 30165
(706) 235-7711
✔ PECOS✔ Accepts MedicareSame address
Jason Smith, M D
Dermatology
NPI 1578586400
103 JOHN MADDOX DR NW
Rome, GA 30165
(706) 235-7711
✔ PECOS✔ Accepts MedicareSame address
Taylor Smith, M.D.
Dermatology
NPI 1316444565
103 JOHN MADDOX DR NW
Rome, GA 30165
(706) 235-7711
✔ PECOS✔ Accepts MedicareSame address
Mallory Fallin, PA-C
Dermatology
NPI 1548805401
103 JOHN MADDOX DR NW
Rome, GA 30165
(706) 235-7711
✔ PECOSSame address
Danielle Lazzara, D.O.
Dermatology
NPI 1912351347
12455 BROADWELL RD STE 102-103
Milton, GA 30004
(770) 375-6197
✔ PECOS✔ Accepts Medicare51 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 for Provider-Performed Microscopy Procedures (PPMP) 11D0716330

Northwest Georgia Dermatology And Skin Surgery Center · Rome, GA
Active · expires Jun 1, 2027
CLIA Number11D0716330
Laboratory TypePhysician Office
Certificate Effective DateJune 2, 2025
Certificate Expiration DateJune 1, 2027
Laboratory DirectorJason L. Smith MD
Laboratory Phone(706) 235-7711
Laboratory LocationNorthwest Georgia Dermatology And Skin Surgery Center103 John Maddox Drive, Rome, GA 30165
CLIA data matches this NPI record on: Address 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 11D2227579

Northwest Georgia Dermatology Mohs Surgery Center · Rome, GA
Active · expires Mar 9, 2027
CLIA Number11D2227579
Laboratory TypePhysician Office
Certificate Effective DateMarch 10, 2025
Certificate Expiration DateMarch 9, 2027
Laboratory DirectorTaylor R. Smith
Laboratory Phone(706) 235-7711
Laboratory LocationNorthwest Georgia Dermatology Mohs Surgery Center101-B John Maddox Drive, NW, Rome, GA 30165
CLIA data matches this NPI record on: 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 Northwest Georgia Dermatology & Skin Surgery Center PC's NPI number?

The NPI number for Northwest Georgia Dermatology & Skin Surgery Center PC is 1467641381. It was assigned to this organization in the NPPES registry on October 16, 2007.

Where is Northwest Georgia Dermatology & Skin Surgery Center PC located?

Northwest Georgia Dermatology & Skin Surgery Center PC is located at 103 John Maddox Dr NW, Rome, GA 30165. The listed phone number is (706) 235-7711.

What is Northwest Georgia Dermatology & Skin Surgery Center PC's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in Procedural Dermatology, with taxonomy code 207NS0135X.

Is Northwest Georgia Dermatology & Skin Surgery Center PC enrolled in Medicare?

Yes. Northwest Georgia Dermatology & Skin Surgery Center PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Northwest Georgia Dermatology & Skin Surgery Center PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 5 clinicians in 2 Medicare specialties reassign their Medicare billing to Northwest Georgia Dermatology & Skin Surgery Center PC. 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 Dermatology (4) and Nurse Practitioner (1). Of these, 4 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Northwest Georgia Dermatology & Skin Surgery Center PC 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 Northwest Georgia Dermatology & Skin Surgery Center PC accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama and Ambetter of North Carolina and 1 other insurer list Northwest Georgia Dermatology & Skin Surgery Center PC 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 Northwest Georgia Dermatology & Skin Surgery Center PC was last updated on October 19, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.