Healthcare Provider Details

I. General information

NPI: 1013918457
Provider Name (Legal Business Name): HOWARD J PEROFSKY M D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 12/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

682 HEMLOCK ST SUITE 230
MACON GA
31201-6883
US

IV. Provider business mailing address

682 HEMLOCK ST SUITE 230
MACON GA
31201-6883
US

V. Phone/Fax

Practice location:
  • Phone: 478-742-4847
  • Fax: 478-742-5442
Mailing address:
  • Phone: 478-742-4847
  • Fax: 478-742-5442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number032452
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: