SUPER DERMATOLOGY LLC
NPI 1669971776
Dermatology in Conyers, GA

Active since February 03, 2018
1364 WELLBROOK CIR NE, CONYERS, GA 30012(770) 285-3533 Get Directions Write a Review

NPPES record last updated: February 3, 2018. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Super Dermatology Llc NPPES

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

SUPER DERMATOLOGY LLC (NPI 1669971776) is a healthcare organization registered as a dermatology in Conyers, Georgia and active in the NPI registry since February 2018. The organization lists Dione Marcus Super, Owner, as its authorized official.

NPPES Registry Identity

NPI1669971776
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameSUPER DERMATOLOGY LLC
Location Address1364 WELLBROOK CIR NEConyers, GA 30012-3872
Mailing Address1351 Audubon Ct SwAtlanta, GA 30311-2471 · (706) 840-4554
Organization SubpartNo
Authorized OfficialDione Marcus SuperOwner · (770) 285-3533
Enumeration DateFebruary 3, 2018
✔ NPI 1669971776 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License✔ Licensed in GA · 60121
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.
1364 WELLBROOK CIR NE, Conyers, GA 30012

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)

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

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Super Dermatology LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Dermatology
NPI 1598974503
1364 WELLBROOK CIR NE
Conyers, GA 30012
(770) 285-3533
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Super Dermatology LLC's NPI number?

The NPI number for Super Dermatology LLC is 1669971776. It was assigned to this organization in the NPPES registry on February 3, 2018.

Where is Super Dermatology LLC located?

Super Dermatology LLC is located at 1364 Wellbrook Cir NE, Conyers, GA 30012. The listed phone number is (770) 285-3533.

What is Super Dermatology LLC's specialty?

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

Is Super Dermatology LLC enrolled in Medicare?

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

How many clinicians bill Medicare through Super Dermatology LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Super 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Super Dermatology LLC was last updated on February 3, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.