Provider Demographics
NPI:1437363751
Name:AOG AESTHETICS
Entity Type:Organization
Organization Name:AOG AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIDGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-278-4640
Mailing Address - Street 1:1105 BURLEYSON RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-3017
Mailing Address - Country:US
Mailing Address - Phone:706-226-7546
Mailing Address - Fax:
Practice Address - Street 1:1105 BURLEYSON RD
Practice Address - Street 2:SUITE 1
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3017
Practice Address - Country:US
Practice Address - Phone:706-226-7546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012695261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAX ID NUMBER