Provider Demographics
NPI:1497897474
Name:PLASTIC SURGERY CENTER OF WEST GEORGIA
Entity Type:Organization
Organization Name:PLASTIC SURGERY CENTER OF WEST GEORGIA
Other - Org Name:WEST GEORGIA CENTER FOR PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:HOUSMAN
Authorized Official - Last Name:KAHLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-834-6302
Mailing Address - Street 1:150 HENRY BURSON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-4465
Mailing Address - Country:US
Mailing Address - Phone:770-834-6302
Mailing Address - Fax:770-834-7660
Practice Address - Street 1:150 HENRY BURSON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4465
Practice Address - Country:US
Practice Address - Phone:770-834-6302
Practice Address - Fax:770-834-7660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030330261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0007849777OtherAETNA
GA0007430251OtherAETNA PPO
GAR566OtherAMERIHEALTH
GA0007430251OtherAETNA PPO