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General NPI Number Information
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NPI Number | 1336546449
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Entity Type | Organization
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Legal Business Name | PLASTIC SURGERY ASSOCIATES OF GEORGIA
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Dates
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Enumeration Date | 12/04/2014
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Last Update Date | 04/22/2015
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Provider Practice Location Address
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Address Line | 5445 MERIDIAN MARKS RD SUITE 395
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City | ATLANTA
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State | GA
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Zip | 30342-4763
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Country | US
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Telephone | 470-440-1777
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Fax | 678-809-5001
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Provider Business Mailing Address
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Address Line | 5445 MERIDIAN MARKS RD SUITE 395
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City | ATLANTA
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State | GA
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Zip | 30342-4763
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Country | US
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Telephone | 470-440-1777
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Fax | 678-809-5001
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Authorized Official
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Title or Position | MANAGER
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Name | NELSON CASTILLO
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Credential | MD
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Telephone | 770-317-9330
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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 | 72195
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 72195
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License Number State | GA
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