Provider Demographics
NPI:1801187802
Name:AESTHETIC PLASTIC SURGERY PC
Entity Type:Organization
Organization Name:AESTHETIC PLASTIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:706-291-0200
Mailing Address - Street 1:506 RIVERSIDE PKWY NE STE 200
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-2902
Mailing Address - Country:US
Mailing Address - Phone:706-291-0200
Mailing Address - Fax:706-291-0248
Practice Address - Street 1:506 RIVERSIDE PKWY NE STE 200
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-2902
Practice Address - Country:US
Practice Address - Phone:706-291-0200
Practice Address - Fax:706-291-0248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000194048BMedicaid
GA000194048BMedicaid