Provider Demographics
NPI:1326171737
Name:ATLANTA PLASTIC & RECONSTRUCTIVE SURGERY CONSULTANTS, PC
Entity Type:Organization
Organization Name:ATLANTA PLASTIC & RECONSTRUCTIVE SURGERY CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:TAYLOR
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:404-875-4017
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:404-875-4017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA40593174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1063418200Medicare PIN
GA1134134901Medicare PIN
GA1487678751Medicare PIN
GA1487835260Medicare PIN
GA1588687289Medicare PIN
GA1508811373Medicare PIN
GA1619941911Medicare PIN
GA1871547877Medicare PIN