Healthcare Provider Details

I. General information

NPI: 1760786024
Provider Name (Legal Business Name): THE GEORGIA CENTER FOR PLASTIC AND RECONSTRUCTIVE SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2010
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6326 PEAKE RD
MACON GA
31210-3960
US

IV. Provider business mailing address

6326 PEAKE RD
MACON GA
31210-3960
US

V. Phone/Fax

Practice location:
  • Phone: 478-254-6608
  • Fax: 478-254-6689
Mailing address:
  • Phone: 478-254-6608
  • Fax: 478-254-6689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JOSHUA RICHARD GROVES
Title or Position: OWNER/CEO
Credential: MD
Phone: 478-254-6608