Healthcare Provider Details

I. General information

NPI: 1356338313
Provider Name (Legal Business Name): PHILIP G. PLOSKA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 N PARK PL STE 101
STOCKBRIDGE GA
30281-7237
US

IV. Provider business mailing address

135 N PARK PL STE 101
STOCKBRIDGE GA
30281-7237
US

V. Phone/Fax

Practice location:
  • Phone: 770-892-0273
  • Fax: 470-878-1495
Mailing address:
  • Phone: 770-892-0273
  • Fax: 470-878-1495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036848
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: