Provider Demographics
NPI:1568638864
Name:GOLDEN ISLES CENTER FOR PLASTIC SURGERY, P.C.
Entity Type:Organization
Organization Name:GOLDEN ISLES CENTER FOR PLASTIC SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-634-1993
Mailing Address - Street 1:1015 ARTHUR J MOORE DR
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-2206
Mailing Address - Country:US
Mailing Address - Phone:912-634-1993
Mailing Address - Fax:912-634-1166
Practice Address - Street 1:1015 ARTHUR J MOORE DR
Practice Address - Street 2:
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-2206
Practice Address - Country:US
Practice Address - Phone:912-634-1993
Practice Address - Fax:912-634-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031386208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111264ASCAMedicare PIN