Provider Demographics
NPI:1225645013
Name:PLASTIC SURGERY GROUP OF ATLANTA, PC
Entity Type:Organization
Organization Name:PLASTIC SURGERY GROUP OF ATLANTA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:CONNORS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:404-348-4456
Mailing Address - Street 1:755 MOUNT VERNON HWY NE STE 250
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4290
Mailing Address - Country:US
Mailing Address - Phone:404-348-4456
Mailing Address - Fax:
Practice Address - Street 1:755 MOUNT VERNON HWY NE STE 250
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4290
Practice Address - Country:US
Practice Address - Phone:404-348-4456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-26
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA60249OtherMEDICAL LICENSE