Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Live Oak Dermatology

Organization Dermatology Physician · NPI 1194209163

Live Oak Dermatology is a Dermatology Physician in Roswell, Georgia. Registered with an NPI since 2018.

In the registry since
2018

Practice location Address checks out

135 Norcross St # 8
Roswell, GA 30075-3867
Phone: (678) 870-2020
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X

Record details

NPI number1194209163
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Brent Goedjen — Ceo · (678) 870-2020
NPI enumeratedSeptember 17, 2018
Last updated in NPPESJuly 22, 2022
Certification dateJuly 22, 2022
Mailing address135 Norcross St # 8, Roswell, GA 30075-3867

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