1518063338 NPI number — THE CENTER FOR PLASTIC & RECONSTRUCTIVE SURGERY, P.C.

Table of content: (NPI 1518063338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518063338 NPI number — THE CENTER FOR PLASTIC & RECONSTRUCTIVE SURGERY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CENTER FOR PLASTIC & RECONSTRUCTIVE SURGERY, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE CTR FOR PLASTIC & R
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518063338
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3320 OLD JEFFERSON RD.
Provider Second Line Business Mailing Address:
BUILDING 100
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-353-3600
Provider Business Mailing Address Fax Number:
706-353-3777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3320 OLD JEFFERSON RD.
Provider Second Line Business Practice Location Address:
BUILDING 100
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-353-3600
Provider Business Practice Location Address Fax Number:
706-353-3777
Provider Enumeration Date:
09/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PARKER
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
706-353-3600

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  0683035 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X , with the licence number: 291-229 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 158255400 . This is a "ACS DEPT OF LABOR" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com