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General NPI Number Information
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NPI Number | 1669927075
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Entity Type | Organization
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Legal Business Name | BREAST BODY BEAUTY LLC
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Dates
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Enumeration Date | 08/16/2016
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 1300 HAWTHORNE AVE SE
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City | SMYRNA
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State | GA
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Zip | 30080-2136
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Country | US
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Telephone | 678-540-1144
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Fax | 678-540-1166
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Provider Business Mailing Address
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Address Line | PO BOX 128
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City | BELLAIRE
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State | TX
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Zip | 77402-0128
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Country | US
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Telephone | 281-833-3330
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Fax | 281-833-3323
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AISHA MCKNIGHT BARON
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Credential | MD
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Telephone | 678-540-1144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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