Provider Demographics
NPI:1225316268
Name:AESTHETIC SURGERY ASSOCIATES
Entity Type:Organization
Organization Name:AESTHETIC SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:404-252-0301
Mailing Address - Street 1:1100 JOHNSON FERRY RD NE
Mailing Address - Street 2:SUITE 850
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1709
Mailing Address - Country:US
Mailing Address - Phone:404-252-0301
Mailing Address - Fax:404-255-3395
Practice Address - Street 1:1100 JOHNSON FERRY ROAD
Practice Address - Street 2:SUITE 850
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-252-0301
Practice Address - Fax:404-255-3398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031901261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty