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General NPI Number Information
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NPI Number | 1710267703
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Entity Type | Organization
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Legal Business Name | AESTHETIC PLASTIC SURGERY CENTER
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Dates
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Enumeration Date | 08/22/2011
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Last Update Date | 10/30/2013
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Provider Practice Location Address
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Address Line | 416 GORDON AVE
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City | THOMASVILLE
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State | GA
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Zip | 31792-6644
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Country | US
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Telephone | 229-228-7200
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Fax | 229-228-5193
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Provider Business Mailing Address
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Address Line | 416 GORDON AVE
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City | THOMASVILLE
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State | GA
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Zip | 31792-6644
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Country | US
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Telephone | 229-228-7200
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Fax | 229-228-5193
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. GEORGE COURTNEY HOUSTON
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Credential | MD
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Telephone | 229-228-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 18675
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License Number State | GA
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