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General NPI Number Information
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NPI Number | 1619214343
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Entity Type | Organization
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Legal Business Name | KALOS SURGICAL ASSOCIATES LLC
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Dates
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Enumeration Date | 01/15/2013
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Last Update Date | 01/15/2013
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Provider Practice Location Address
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Address Line | 5670 PEACHTREE DUNWOODY RD NE STE 910
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City | ATLANTA
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State | GA
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Zip | 30342-1699
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Country | US
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Telephone | 404-963-6665
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Fax |
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Provider Business Mailing Address
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Address Line | 5670 PEACHTREE DUNWOODY RD NE STE 910
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City | ATLANTA
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State | GA
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Zip | 30342-1699
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Country | US
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Telephone | 404-963-6665
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. BENJAMIN COLLIN STONG
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Credential | M.D.
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Telephone | 404-963-6665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | 54676
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License Number State | GA
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