Healthcare Provider Details

I. General information

NPI: 1780888156
Provider Name (Legal Business Name): PLASTIC AND RECONSTRUCTIVE SURGERY CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 04/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 SAINT SEBASTIAN WAY SUITE 1A
AUGUSTA GA
30901-2643
US

IV. Provider business mailing address

820 SAINT SEBASTIAN WAY SUITE 1A
AUGUSTA GA
30901-2643
US

V. Phone/Fax

Practice location:
  • Phone: 706-724-7288
  • Fax: 706-724-7394
Mailing address:
  • Phone: 706-724-7288
  • Fax: 706-724-7394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GEORGE STEPHENSON DREW
Title or Position: OWNER CEO
Credential: MD
Phone: 706-724-7288