Healthcare Provider Details

I. General information

NPI: 1518931641
Provider Name (Legal Business Name): FACES PLASTIC SURGERY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 W NC HIGHWAY 54 SUITE 130
DURHAM NC
27707-5574
US

IV. Provider business mailing address

1515 W NC HIGHWAY 54 SUITE 130
DURHAM NC
27707-5574
US

V. Phone/Fax

Practice location:
  • Phone: 919-419-8319
  • Fax: 919-489-4514
Mailing address:
  • Phone: 919-419-8319
  • Fax: 919-489-4514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number9900840
License Number StateNC

VIII. Authorized Official

Name: MS. ATHINA ALEXANDROS GIANNOPOULOS
Title or Position: OWNER & PHYSICIAN
Credential: M.D.
Phone: 919-419-8319