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NPI Code Detail

MEDICARE: CLEAVER MEDICAL GROUP DERMATOLOGY INC

MEDICARE: CLEAVER MEDICAL GROUP DERMATOLOGY INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ND0900XDermatopathology Physician
2207ND0101XMOHS-Micrographic Surgery Physician
3207N00000XDermatology Physician

General Provider Information

NPI Number : 1841852076
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLEAVER MEDICAL GROUP DERMATOLOGY INC
Provider Business Mailing Address
First Line : 59 TIPTON DR
Second Line :
City : DAHLONEGA
State : GA
Zip : 30533-1603
Country : US
Telephone Number : 770-800-3455
Fax Number : 770-284-8380
Provider Business Practice Location Address
First Line : 105 PROFESSIONAL PARK DR
Second Line :
City : CUMMING
State : GA
Zip : 30040-2381
Country : US
Telephone Number : 770-800-3455
Fax Number : 770-284-8380
Authorized Official
Title or Position : PRACTICE ADMINISTRATOR
Name : ASHLEY N DORSEY
Credential :
Telephone Number : 770-746-6380
Provider Enumeration Date : 07/09/2019
Last Update Date : 12/02/2025

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Directions to “CLEAVER MEDICAL GROUP DERMATOLOGY INC ” Practice Location

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