Provider Demographics
NPI:1578211520
Name:GEORGIA CENTER FOR AESTHETIC PLASTIC SURGERY LLC
Entity Type:Organization
Organization Name:GEORGIA CENTER FOR AESTHETIC PLASTIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-705-2765
Mailing Address - Street 1:2053 EXPERIMENT STATION RD
Mailing Address - Street 2:BUILDING 300
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677
Mailing Address - Country:US
Mailing Address - Phone:706-705-2765
Mailing Address - Fax:
Practice Address - Street 1:2053 EXPERIMENT STATION RD
Practice Address - Street 2:BUILDING 300
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677
Practice Address - Country:US
Practice Address - Phone:706-705-2765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty