NPI age
10 years
Enumerated 2015-11-17
● Active
Type 1 · Individual
Supriya Immaneni, MD
Immaneni is 1 of 4 dermatology providers in MacOn and 1 of 55 in Georgia.
Primary specialty
Dermatology
Plus 1 subspecialty
Licensed in
GA
1 state
Status
Active
No deactivations on record
Last NPPES update
2026-01-13
Source: monthly bulk 2026-05
Sole proprietor
No
May be part of a larger org
How this provider compares
Across 55 active dermatology providers in Georgia.
NPI age
10 years
↓ 9 yr below median (19 yr)
State licenses
1 state
23% of peers hold multiple states
Subspecialties
1
In the 65% of peers with subspecialties
NPI lifetime · 2015 → 2026
2015-11Enumerated in NPPES
2015
2026
Where they practice
Practice location
308 Coliseum Dr, St 200
MacOn, GA 312173865
Mailing address
308 Coliseum Dr, St 200
MacOn, GA 312173865
Specialties
-
Dermatology PrimaryThe highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased...
-
DermatologyA dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The...
Practice context
Part of a multi-provider practice. 20 other active providers share this practice address in NPPES.
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