Live Oak Dermatology
NPI 1194209163 · Dermatology Physician · Roswell, GA
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Live Oak Dermatology is a Dermatology Physician organization in Roswell, GA (NPI 1194209163).
Provider details
- NPI number
- 1194209163
- Entity type
- Organization
- Primary specialty
- Dermatology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Brent Goedjen, Ceo(678) 870-2020
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
7 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2018-09-17
- Last updated
- 2022-07-22
- Certified
- 2022-07-22
Frequently asked questions
- What is Live Oak Dermatology's NPI number?
- Live Oak Dermatology's National Provider Identifier (NPI) is 1194209163, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Live Oak Dermatology?
- Live Oak Dermatology is classified in the NPPES registry as Dermatology Physician (Allopathic & Osteopathic Physicians).
- Where is Live Oak Dermatology located?
- Live Oak Dermatology's practice location on file with NPPES is 135 Norcross St # 8, Roswell, GA 30075-3867.
- What is Live Oak Dermatology's phone number?
- The practice phone number listed in the NPPES registry for Live Oak Dermatology is (678) 870-2020.
- Does Live Oak Dermatology accept Medicare?
- Live Oak Dermatology is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Live Oak Dermatology?
- The authorized official listed on Live Oak Dermatology's NPPES record is Brent Goedjen, Ceo. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Live Oak Dermatology's NPI active?
- Yes — Live Oak Dermatology's NPI (1194209163) is active in the NPPES registry as of the last update on 2022-07-22.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.