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General NPI Number Information
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NPI Number | 1255597282
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Entity Type | Organization
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Legal Business Name | PLASTIC SURGERY INSTITUTE OF ATLANTA, P.C.
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Dates
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Enumeration Date | 07/30/2008
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Last Update Date | 07/30/2008
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Provider Practice Location Address
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Address Line | 960 JOHNSON FERRY RD NE SUITE 245
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City | ATLANTA
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State | GA
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Zip | 30342-1631
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Country | US
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Telephone | 404-499-0111
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Fax | 404-499-0114
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Provider Business Mailing Address
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Address Line | 960 JOHNSON FERRY RD NE SUITE 245
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City | ATLANTA
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State | GA
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Zip | 30342-1631
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Country | US
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Telephone | 404-499-0111
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Fax | 404-499-0114
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | PAUL MCCLUSKEY
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Credential | MD
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Telephone | 404-499-0111
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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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