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General NPI Number Information
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NPI Number | 1225645013
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Entity Type | Organization
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Legal Business Name | PLASTIC SURGERY GROUP OF ATLANTA, PC
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Dates
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Enumeration Date | 09/26/2020
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Last Update Date | 10/09/2020
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Provider Practice Location Address
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Address Line | 755 MOUNT VERNON HWY NE STE 250
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City | ATLANTA
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State | GA
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Zip | 30328-4290
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Country | US
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Telephone | 404-348-4456
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Fax |
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Provider Business Mailing Address
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Address Line | 755 MOUNT VERNON HWY NE STE 250
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City | ATLANTA
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State | GA
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Zip | 30328-4290
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Country | US
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Telephone | 404-348-4456
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JOHN PHILIP CONNORS III
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Credential | MD
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Telephone | 404-348-4456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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