Healthcare Provider Details

I. General information

NPI: 1801133699
Provider Name (Legal Business Name): SAVANNAH RIVER PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2013
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 ST. SEBASTIAN WAY SUITE 1A
AUGUSTA GA
30901-2635
US

IV. Provider business mailing address

820 ST. SEBASTIAN WAY SUITE 1A
AUGUSTA GA
30901-2635
US

V. Phone/Fax

Practice location:
  • Phone: 706-651-8400
  • Fax: 706-651-8868
Mailing address:
  • Phone: 706-651-8400
  • Fax: 706-651-8868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number024290
License Number StateGA

VIII. Authorized Official

Name: DR. BILLY P LYNN
Title or Position: OWNER
Credential: MD
Phone: 706-651-8400