Healthcare Provider Details

I. General information

NPI: 1194905182
Provider Name (Legal Business Name): CHATTAHOOCHEE PLASTIC SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 WHITTLESEY RD SUITE 200
COLUMBUS GA
31904-3099
US

IV. Provider business mailing address

1921 WHITTLESEY RD SUITE 200
COLUMBUS GA
31904-3099
US

V. Phone/Fax

Practice location:
  • Phone: 706-494-7700
  • Fax: 706-494-8800
Mailing address:
  • Phone: 706-494-7700
  • Fax: 706-494-8800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number040497
License Number StateGA

VIII. Authorized Official

Name: ANGIE COATES
Title or Position: ASSISTANT MANAGER
Credential:
Phone: 706-494-7700