Healthcare Provider Details

I. General information

NPI: 1275738528
Provider Name (Legal Business Name): ARTISAN PLASTIC SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5670 PEACHTREE DUNWOODY RD STE 820
ATLANTA GA
30342-4717
US

IV. Provider business mailing address

5670 PEACHTREE DUNWOODY RD STE 820
ATLANTA GA
30342-4717
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-1998
  • Fax: 404-528-2886
Mailing address:
  • Phone: 404-851-1998
  • Fax: 404-528-2886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberSBL010388
License Number StateGA

VIII. Authorized Official

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