Healthcare Provider Details

I. General information

NPI: 1952841447
Provider Name (Legal Business Name): OPHTHALMIC PLASTIC AND COSMETIC SURGERY, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 HOWELL MILL RD NW SUITE 321
ATLANTA GA
30327-4111
US

IV. Provider business mailing address

3280 HOWELL MILL RD NW SUITE 321
ATLANTA GA
30327-4111
US

V. Phone/Fax

Practice location:
  • Phone: 404-946-8323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number76141
License Number StateGA

VIII. Authorized Official

Name: DR. MICHAEL NEIMKIN
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 205-222-2611