MEDICARE: ARTISAN PLASTIC SURGERY, LLC

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
1	174400000X	Specialist	SBL010388	GA

General Provider Information

NPI Number	:	1275738528
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARTISAN PLASTIC SURGERY, LLC

Provider Business Mailing Address
First Line	:	5670 PEACHTREE DUNWOODY RD
Second Line	:	STE 820
City	:	ATLANTA
State	:	GA
Zip	:	30342-4717
Country	:	US
Telephone Number	:	404-851-1998
Fax Number	:	404-528-2886

Provider Business Practice Location Address
First Line	:	5670 PEACHTREE DUNWOODY RD
Second Line	:	STE 820
City	:	ATLANTA
State	:	GA
Zip	:	30342-4717
Country	:	US
Telephone Number	:	404-851-1998
Fax Number	:	404-528-2886

Authorized Official
Title or Position	:	OWNER, MEDICAL DOCTOR
Name	:	DR. DIANE Z. ALEXANDER
Credential	:	M.D.
Telephone Number	:	404-857-1998

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	11/02/2016

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