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General NPI Number Information
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NPI Number | 1124046990
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Entity Type | Organization
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Legal Business Name | PLASTIKOS PLASTIC AND RECONSTRUCTIVE SURGERY
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 12/28/2007
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Provider Practice Location Address
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Address Line | 4370 GEORGETOWN SQ
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City | ATLANTA
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State | GA
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Zip | 30338-6205
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Country | US
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Telephone | 770-457-4677
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Fax | 770-457-4428
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Provider Business Mailing Address
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Address Line | 4370 GEORGETOWN SQ
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City | ATLANTA
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State | GA
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Zip | 30338-6205
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Country | US
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Telephone | 770-457-4677
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Fax | 770-457-4428
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Authorized Official
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Title or Position | OWNER/PLASTIC SURGEON
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Name | DR. SUSAN KOLB
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Credential | M.D.
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Telephone | 770-457-4677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2082S0105X
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Taxonomy Name | Surgery of the Hand (Plastic Surgery) Physician
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License Number | 31272
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | POD001047
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | POD001047
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 31272
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License Number State | GA
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