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General NPI Number Information
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NPI Number | 1013990308
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Entity Type | Organization
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Legal Business Name | AUGUSTA PLASTIC SURGERY CENTER, INC.
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Dates
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Enumeration Date | 11/21/2005
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Last Update Date | 07/22/2020
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Provider Practice Location Address
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Address Line | 569 FURYS FERRY RD
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City | MARTINEZ
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State | GA
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Zip | 30907-9059
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Country | US
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Telephone | 706-724-5611
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Fax | 706-724-5435
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Provider Business Mailing Address
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Address Line | 569 FURYS FERRY RD
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City | MARTINEZ
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State | GA
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Zip | 30907-9059
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Country | US
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Telephone | 706-724-5611
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Fax | 706-724-5435
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | CHARON P BARTLEY
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Credential |
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Telephone | 706-724-5611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 121-114
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License Number State | GA
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