Provider Demographics
NPI:1346650421
Name:COMPLEXIONS MEDICAL AESTHETICS, LLC
Entity Type:Organization
Organization Name:COMPLEXIONS MEDICAL AESTHETICS, LLC
Other - Org Name:COMPLEXIONS ATLANTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOX NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:770-727-5461
Mailing Address - Street 1:4170 OAK TREE CT
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30344-7033
Mailing Address - Country:US
Mailing Address - Phone:770-727-5461
Mailing Address - Fax:
Practice Address - Street 1:4705 ASHFORD DUNWOODY RD STE A
Practice Address - Street 2:SUITE 14
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-5566
Practice Address - Country:US
Practice Address - Phone:770-727-5461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center