Marietta Dermatology Associates PA
NPI 1417007212 · Dermatology Physician · Marietta, GA
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Marietta Dermatology Associates PA is a Dermatology Physician organization in Marietta, GA (NPI 1417007212).
Provider details
- NPI number
- 1417007212
- Entity type
- Organization
- Primary specialty
- Dermatology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Gobin Coppa, Director of Billing Office(770) 422-1013
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
19 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
- 2007-01-12
- Last updated
- 2023-04-28
- Certified
- 2023-04-28
Frequently asked questions
- What is Marietta Dermatology Associates PA's NPI number?
- Marietta Dermatology Associates PA's National Provider Identifier (NPI) is 1417007212, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Marietta Dermatology Associates PA?
- Marietta Dermatology Associates PA is classified in the NPPES registry as Dermatology Physician (Allopathic & Osteopathic Physicians).
- Where is Marietta Dermatology Associates PA located?
- Marietta Dermatology Associates PA's practice location on file with NPPES is 111 Marble Mill Rd Nw, Marietta, GA 30060-1047.
- What is Marietta Dermatology Associates PA's phone number?
- The practice phone number listed in the NPPES registry for Marietta Dermatology Associates PA is (770) 422-1013.
- Does Marietta Dermatology Associates PA accept Medicare?
- Marietta Dermatology Associates PA 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 Marietta Dermatology Associates PA?
- The authorized official listed on Marietta Dermatology Associates PA's NPPES record is Gobin Coppa, Director of Billing Office. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Marietta Dermatology Associates PA's NPI active?
- Yes — Marietta Dermatology Associates PA's NPI (1417007212) is active in the NPPES registry as of the last update on 2023-04-28.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.