Healthcare Provider Details

I. General information

NPI: 1144506023
Provider Name (Legal Business Name): ATLANTA SURGICAL ARTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6133 PEACHTREE DUNWOODY RD
ATLANTA GA
30328-5332
US

IV. Provider business mailing address

6133 PEACHTREE DUNWOODY RD
ATLANTA GA
30328-5332
US

V. Phone/Fax

Practice location:
  • Phone: 678-412-0311
  • Fax:
Mailing address:
  • Phone: 678-412-0311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN012723
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: CANG HUYNH
Title or Position: PRESIDENT
Credential: MD
Phone: 404-516-3789