Provider Demographics
NPI:1255500237
Name:PLASTIC SURGICAL SERVICES, PC
Entity Type:Organization
Organization Name:PLASTIC SURGICAL SERVICES, PC
Other - Org Name:THE AESTHETIC INSTITUTE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LOIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-979-1277
Mailing Address - Street 1:2121 FOUNTAIN DR STE K
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2900
Mailing Address - Country:US
Mailing Address - Phone:770-979-1277
Mailing Address - Fax:
Practice Address - Street 1:2121 FOUNTAIN DR STE K
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2900
Practice Address - Country:US
Practice Address - Phone:770-979-1277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA021175208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty