Healthcare Provider Details

I. General information

NPI: 1023259454
Provider Name (Legal Business Name): FACESFIRST,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2009
Last Update Date: 03/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1741 PATRIOTS WAY NW
KENNESAW GA
30152-4859
US

IV. Provider business mailing address

1741 PATRIOTS WAY NW
KENNESAW GA
30152-4859
US

V. Phone/Fax

Practice location:
  • Phone: 678-392-6808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number41239
License Number StateGA

VIII. Authorized Official

Name: ELIZABETH G WHITAKER
Title or Position: SOLE OWNER
Credential: MD
Phone: 678-392-6808