Provider Demographics
NPI:1518063338
Name:THE CENTER FOR PLASTIC & RECONSTRUCTIVE SURGERY, P.C.
Entity Type:Organization
Organization Name:THE CENTER FOR PLASTIC & RECONSTRUCTIVE SURGERY, P.C.
Other - Org Name:THE CTR FOR PLASTIC & R
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-353-3600
Mailing Address - Street 1:3320 OLD JEFFERSON RD.
Mailing Address - Street 2:BUILDING 100
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607
Mailing Address - Country:US
Mailing Address - Phone:706-353-3600
Mailing Address - Fax:706-353-3777
Practice Address - Street 1:3320 OLD JEFFERSON RD.
Practice Address - Street 2:BUILDING 100
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607
Practice Address - Country:US
Practice Address - Phone:706-353-3600
Practice Address - Fax:706-353-3777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0683035261Q00000X
GA291-229261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA158255400OtherACS DEPT OF LABOR
GA111197ASCAMedicare PIN