Provider Demographics
NPI:1649217001
Name:PACES PLASTIC SURGERY, INC.
Entity Type:Organization
Organization Name:PACES PLASTIC SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:T.RODERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:404-351-0051
Mailing Address - Street 1:3200 DOWNWOOD CIR NW
Mailing Address - Street 2:640
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-1610
Mailing Address - Country:US
Mailing Address - Phone:404-351-0051
Mailing Address - Fax:404-351-0632
Practice Address - Street 1:3200 DOWNWOOD CIR NW
Practice Address - Street 2:640
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-1610
Practice Address - Country:US
Practice Address - Phone:404-351-0051
Practice Address - Fax:404-351-0632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical