MEDICARE: ESJ AESTHETICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician

General Provider Information

NPI Number	:	1063251668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESJ AESTHETICS LLC

Provider Business Mailing Address
First Line	:	1730 MOUNT VERNON RD STE A
Second Line	:
City	:	DUNWOODY
State	:	GA
Zip	:	30338-4245
Country	:	US
Telephone Number	:	770-466-4700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 MOUNT VERNON RD STE A
Second Line	:
City	:	DUNWOODY
State	:	GA
Zip	:	30338-4245
Country	:	US
Telephone Number	:	770-466-4700
Fax Number	:	678-737-1760

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EARL STEPHENSON JR.
Credential	:	MD
Telephone Number	:	770-466-4700

Provider Enumeration Date	:	05/22/2024
Last Update Date	:	05/22/2024

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