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ADVANCED DERMATOLOGY,P.C.
NPI 1932360757
Specialist in Douglasville, GA

Active since June 24, 2008CLIA 11D0950417 · Certificate of Compliance
4904 TIMBER RIDGE DR STE 101, DOUGLASVILLE, GA 30135(770) 739-7546(770) 739-7920 Get Directions Write a Review

NPPES record last updated: June 21, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Advanced Dermatology,p.c. NPPES

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

ADVANCED DERMATOLOGY,P.C. (NPI 1932360757) is a healthcare organization registered as a specialist in Douglasville, Georgia and active in the NPI registry since June 2008. The organization holds a CLIA Certificate of Compliance certificate valid through February 14, 2027 and lists Amr A Agha, Owner, as its authorized official.

NPPES Registry Identity

NPI1932360757
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameADVANCED DERMATOLOGY,P.C.
Location Address4904 TIMBER RIDGE DR STE 101Douglasville, GA 30135-1831
Mailing Address4904 Timber Ridge Dr Ste 101Douglasville, GA 30135-1831 · (770) 739-7546 · Fax (770) 739-7920
Phone(770) 739-7546
Fax(770) 739-7920
Organization SubpartNo
Authorized OfficialAmr A AghaOwner · (770) 739-7546
Enumeration DateJune 24, 2008
Last NPPES UpdateJune 21, 2024
NPPES CertifiedJune 21, 2024
✔ NPI 1932360757 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in GA · 037741
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
4904 TIMBER RIDGE DR STE 101, Douglasville, GA 30135
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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

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)

Advanced Dermatology,p.c. 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 Advanced Dermatology,p.C., which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.

Clinicians, nearest first (5)

Amr Agha, M.D.
Dermatology
NPI 1184673238
4904 TIMBER RIDGE DR SUITE101
Douglasville, GA 30135
(770) 739-7546
✔ PECOS✔ Accepts MedicareSame address
Jessi Jacobi, FNP-C
Nurse Practitioner
NPI 1265319677
2659 ROLLING VIEW DR SE
Smyrna, GA 30080
(256) 312-7825
✔ PECOS✔ Accepts Medicare18 mi
Elana Gebhard-Koenigstein, NP-C
Nurse Practitioner
NPI 1316516875
1365 CLIFTON RD NE
Atlanta, GA 30322
(404) 778-4500
✔ PECOS✔ Accepts Medicare24 mi
Rebecca Paffenroth, APRN
Nurse Practitioner
NPI 1720543218
2579 HIGHWAY 54
Peachtree City, GA 30269
(770) 487-2645
✔ PECOS✔ Accepts Medicare24 mi
Mark Crawshaw, FNP-BC
Nurse Practitioner
NPI 1265009559
1600 CONTINENTAL PL STE 101
Mount Vernon, WA 98273
(360) 336-3026
✔ PECOS✔ Accepts Medicare2,180 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 of Compliance 11D0950417

Advanced Dermatology · Douglasville, GA
Active · expires Feb 14, 2027
CLIA Number11D0950417
Laboratory TypePhysician Office
Certificate Effective DateFebruary 15, 2025
Certificate Expiration DateFebruary 14, 2027
Laboratory DirectorAmr A. Agha MD
Laboratory Phone(770) 739-7546
Laboratory LocationAdvanced Dermatology4904 Timber Ridge Dr Suite 101, Douglasville, GA 30135
CLIA data matches this NPI record on: Address 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.

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 Advanced Dermatology,p.C.'s NPI number?

The NPI number for Advanced Dermatology,p.C. is 1932360757. It was assigned to this organization in the NPPES registry on June 24, 2008.

Where is Advanced Dermatology,p.C. located?

Advanced Dermatology,p.C. is located at 4904 Timber Ridge Dr Ste 101, Douglasville, GA 30135. The listed phone number is (770) 739-7546.

What is Advanced Dermatology,p.C.'s specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Advanced Dermatology,p.C. enrolled in Medicare?

Yes. Advanced Dermatology,p.C. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Advanced Dermatology,p.C.?

According to the CMS Revalidation Reassignment List (October 2026 release), 5 clinicians in 2 Medicare specialties reassign their Medicare billing to Advanced Dermatology,p.C.. 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 (4) and Dermatology (1). Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Advanced Dermatology,p.C. hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 11D0950417) is associated with this NPI, valid through February 14, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Advanced Dermatology,p.C. 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 Advanced Dermatology,p.C. 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 Advanced Dermatology,p.C. was last updated on June 21, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.