Healthcare Provider Details

I. General information

NPI: 1851411490
Provider Name (Legal Business Name): PLASTIC AND RECONSTRUCTIVE SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 STOVALL ST
AUGUSTA GA
30904-4883
US

IV. Provider business mailing address

1433 STOVALL ST
AUGUSTA GA
30904-4883
US

V. Phone/Fax

Practice location:
  • Phone: 706-736-6806
  • Fax: 706-733-1168
Mailing address:
  • Phone: 706-736-6806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number017993
License Number StateGA

VIII. Authorized Official

Name: DR. WILLIAM J WELSH
Title or Position: PRESIDENT
Credential: M.D
Phone: 706-736-6806