Provider Demographics
NPI:1427368315
Name:BUCKHEAD PLASTIC SURGERY
Entity Type:Organization
Organization Name:BUCKHEAD PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-367-9005
Mailing Address - Street 1:4684 ROSWELL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3074
Mailing Address - Country:US
Mailing Address - Phone:404-367-9005
Mailing Address - Fax:678-240-4188
Practice Address - Street 1:4684 ROSWELL RD
Practice Address - Street 2:SUITE B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3074
Practice Address - Country:US
Practice Address - Phone:404-367-9005
Practice Address - Fax:678-240-4188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045278208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty