Healthcare Provider Details

I. General information

NPI: 1730422346
Provider Name (Legal Business Name): PLASTIC SURGERY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 ACWORTH DUE WEST RD BLDG 200 STE 220
KENNESAW GA
30144-1078
US

IV. Provider business mailing address

3450 ACWORTH DUE WEST RD BLDG 200 STE 220
KENNESAW GA
30144-1078
US

V. Phone/Fax

Practice location:
  • Phone: 770-794-6643
  • Fax: 770-794-6683
Mailing address:
  • Phone: 770-794-6643
  • Fax: 770-794-6683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MARCUS H. CRAWFORD
Title or Position: OWNER/CEO
Credential: MD
Phone: 770-794-6643