Healthcare Provider Details

I. General information

NPI: 1134104680
Provider Name (Legal Business Name): ATLANTA PLASTIC SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 12/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 JOHNSON FERRY RD NE SUITE 100
ATLANTA GA
30342-1619
US

IV. Provider business mailing address

975 JOHNSON FERRY RD NE SUITE 100
ATLANTA GA
30342-1619
US

V. Phone/Fax

Practice location:
  • Phone: 404-256-1311
  • Fax: 404-705-2772
Mailing address:
  • Phone: 404-256-1311
  • Fax: 404-705-2772

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: BETH FREEMAN
Title or Position: HIPPA COMPLIANCE OFFICER
Credential:
Phone: 404-256-1311