Dermatology Specialists of West Georgia – Dermatology Physician, NPI 1780658203
Dermatology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Dermatology Specialists of West Georgia
112 WILSHIRE VILLAGE DR
PEACHTREE CITY, GA 302693138
Phone: (770) 636-3376
Fax: (770) 838-7755
Type: Mailing
109 PROFESSIONAL PL
CARROLLTON, GA 301173862
Phone: (770) 838-9333
Fax: (770) 838-7755
Type: Location
112 Wilshire Village Dr
Peachtree City, GA 302693138
Phone: (770) 636-3376
Type: Location
354 Newnan Crossing Byp Ste 205
Newnan, GA 302652434
Phone: (770) 520-8561
Type: Location
601 DIXIE ST
CARROLLTON, GA 301173816
Phone: (770) 838-9333
Fax: (770) 838-7755
Type: Location
109 PROFESSIONAL PLACE
CARROLLTON, GA 301173862
Phone: (770) 838-9333
Fax: (770) 838-7755
Type: Location
157, Clinic Avenue, Carrollton, Carroll County, Georgia, 30117, United States
SUITE 301
CARROLLTON, GA 301174413
Phone: (770) 838-9333
Fax: (770) 838-7755
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2005-06-28
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2025-09-30 (251 days ago).
Enrollment records
1
Earliest due date
2025-09-30
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20050628000964 | O | Clinic/Group Practice | GA | 2025-09-30 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 30269)
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