Provider Demographics
NPI:1679879654
Name:AESTHETICA SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:AESTHETICA SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:POTYONDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-228-9900
Mailing Address - Street 1:505 GORDON AVE
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6645
Mailing Address - Country:US
Mailing Address - Phone:229-228-9900
Mailing Address - Fax:229-228-9477
Practice Address - Street 1:505 GORDON AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6645
Practice Address - Country:US
Practice Address - Phone:229-228-9900
Practice Address - Fax:229-228-9477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057743208200000X
261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty