Healthcare Provider Details

I. General information

NPI: 1225316268
Provider Name (Legal Business Name): AESTHETIC SURGERY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 JOHNSON FERRY ROAD SUITE 850
ATLANTA GA
30342
US

IV. Provider business mailing address

1100 JOHNSON FERRY RD NE SUITE 850
ATLANTA GA
30342-1709
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-0301
  • Fax: 404-255-3398
Mailing address:
  • Phone: 404-252-0301
  • Fax: 404-255-3395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number031901
License Number StateGA

VIII. Authorized Official

Name: DR. JAMES W. DAVIS JR.
Title or Position: OWNER
Credential: M.D.
Phone: 404-252-0301