Provider Demographics
NPI:1073706412
Name:PLASTIC SURGERY OF ATHENS, P.C.
Entity Type:Organization
Organization Name:PLASTIC SURGERY OF ATHENS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-353-3600
Mailing Address - Street 1:3320 OLD JEFFERSON RD
Mailing Address - Street 2:BLDG 100
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607-1400
Mailing Address - Country:US
Mailing Address - Phone:706-353-3600
Mailing Address - Fax:706-353-3777
Practice Address - Street 1:3320 OLD JEFFERSON RD
Practice Address - Street 2:BLDG 100
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-1400
Practice Address - Country:US
Practice Address - Phone:706-353-3600
Practice Address - Fax:706-353-3777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2399Medicare PIN