Epiphany Dermatology of Georgia, LLC
NPI 1265544357ActiveOrganization· Dermatology· Fayetteville, GA
Dermatology in Fayetteville, Georgia, registered in NPPES in August 2006. The authorized official on file is Gheorghe Pusta, Executive Director. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1265544357 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Aug 31, 2006 |
| Last updated in NPPES | Mar 19, 2025 |
| Certified by provider | Mar 19, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dermatology Primary | 207N00000X | — | — |
| Dermatology, MOHS-Micrographic Surgery | 207ND0101X | — | — |
| Dermatology, Procedural Dermatology | 207NS0135X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (GA) |
|---|
Other Dermatology providers in Fayetteville
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