Healthcare Provider Details

I. General information

NPI: 1396892535
Provider Name (Legal Business Name): COLUMBUS PLASTIC & COSMETIC SURGERY CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 NORTH AVE
COLUMBUS GA
31904-8839
US

IV. Provider business mailing address

2200 NORTH AVE
COLUMBUS GA
31904-8839
US

V. Phone/Fax

Practice location:
  • Phone: 706-327-5547
  • Fax: 706-323-6821
Mailing address:
  • Phone: 706-327-5547
  • Fax: 706-323-6821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. VICKI H GILBERT
Title or Position: OFFICE MANAGER
Credential:
Phone: 706-327-5547