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General NPI Number Information
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NPI Number | 1952836835
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Entity Type | Organization
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Legal Business Name | GEORGIA PLASTIC SURGERY & RECONSTRUCTIVE CARE PC
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Dates
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Enumeration Date | 04/27/2017
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Last Update Date | 04/27/2017
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Provider Practice Location Address
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Address Line | 631 PROFESSIONAL DR SUITE 240
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-3367
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Country | US
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Telephone | 678-407-4988
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Fax | 706-407-4972
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Provider Business Mailing Address
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Address Line | 631 PROFESSIONAL DR SUITE 240
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-3367
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Country | US
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Telephone | 678-407-4988
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Fax | 706-407-4972
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Authorized Official
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Title or Position | PRESIDENT
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Name | PIOTR P SKOWRONSKI
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Credential | MD
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Telephone | 678-407-4988
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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 | 65617
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License Number State | GA
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