Healthcare Provider Details

I. General information

NPI: 1841852076
Provider Name (Legal Business Name): CLEAVER MEDICAL GROUP DERMATOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 PROFESSIONAL PARK DR
CUMMING GA
30040-2381
US

IV. Provider business mailing address

59 TIPTON DR
DAHLONEGA GA
30533-1603
US

V. Phone/Fax

Practice location:
  • Phone: 770-800-3455
  • Fax: 770-284-8380
Mailing address:
  • Phone: 770-800-3455
  • Fax: 770-284-8380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY N DORSEY
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 770-746-6380