Provider Demographics
NPI:1275738528
Name:ARTISAN PLASTIC SURGERY, LLC
Entity Type:Organization
Organization Name:ARTISAN PLASTIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:Z
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-857-1998
Mailing Address - Street 1:5670 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:STE 820
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4717
Mailing Address - Country:US
Mailing Address - Phone:404-851-1998
Mailing Address - Fax:404-528-2886
Practice Address - Street 1:5670 PEACHTREE DUNWOODY RD
Practice Address - Street 2:STE 820
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4717
Practice Address - Country:US
Practice Address - Phone:404-851-1998
Practice Address - Fax:404-528-2886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASBL010388174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty