Provider Demographics
NPI:1497871990
Name:ADVANCED AESTHETIC SURGERY
Entity Type:Organization
Organization Name:ADVANCED AESTHETIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:LINTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-771-5151
Mailing Address - Street 1:700 CANTON RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7210
Mailing Address - Country:US
Mailing Address - Phone:770-771-5151
Mailing Address - Fax:770-771-5150
Practice Address - Street 1:711 CANTON RD NE
Practice Address - Street 2:SUITE 400
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8948
Practice Address - Country:US
Practice Address - Phone:770-771-5151
Practice Address - Fax:770-771-5150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0272202086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA24BCBWNMedicare ID - Type Unspecified
GAF08365Medicare UPIN