Healthcare Provider Details

I. General information

NPI: 1235612862
Provider Name (Legal Business Name): CENTER FOR SURGICAL ARTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 STONE MOUNTAIN HWY
LILBURN GA
30047-4614
US

IV. Provider business mailing address

4650 STONE MOUNTAIN HWY
LILBURN GA
30047-4614
US

V. Phone/Fax

Practice location:
  • Phone: 678-344-2450
  • Fax: 678-344-2501
Mailing address:
  • Phone: 678-344-2450
  • Fax: 678-344-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SYLVIA RICHARDSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 678-344-2450