Provider Demographics
NPI:1225051584
Name:ATLANTA PLASTIC & RECONSTRUCTIVE SURGERY CENTER, PC
Entity Type:Organization
Organization Name:ATLANTA PLASTIC & RECONSTRUCTIVE SURGERY CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:T
Authorized Official - Last Name:WORK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:404-885-9675
Mailing Address - Street 1:1 BALTIMORE PL NW
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2116
Mailing Address - Country:US
Mailing Address - Phone:404-885-9675
Mailing Address - Fax:404-759-2212
Practice Address - Street 1:1 BALTIMORE PL NW
Practice Address - Street 2:SUITE 400
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2116
Practice Address - Country:US
Practice Address - Phone:404-885-9675
Practice Address - Fax:404-759-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040593261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAX57002Medicare UPIN
GA111175ASCBMedicare ID - Type Unspecified