Healthcare Provider Details

I. General information

NPI: 1487582110
Provider Name (Legal Business Name): GREATER ATLANTA PLASTIC SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11681 HAYNES BRIDGE RD STE 100
ALPHARETTA GA
30009-2712
US

IV. Provider business mailing address

11681 HAYNES BRIDGE RD STE 100
ALPHARETTA GA
30009-2712
US

V. Phone/Fax

Practice location:
  • Phone: 770-475-3146
  • Fax: 678-215-0688
Mailing address:
  • Phone: 770-475-3146
  • Fax: 678-215-0688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KSHITIJ VIPIN MAJMUNDAR
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: MD
Phone: 770-475-3146