Provider Demographics
NPI:1851411490
Name:PLASTIC AND RECONSTRUCTIVE SURGERY PC
Entity Type:Organization
Organization Name:PLASTIC AND RECONSTRUCTIVE SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:WELSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-736-6806
Mailing Address - Street 1:1433 STOVALL ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4883
Mailing Address - Country:US
Mailing Address - Phone:706-736-6806
Mailing Address - Fax:
Practice Address - Street 1:1433 STOVALL ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4883
Practice Address - Country:US
Practice Address - Phone:706-736-6806
Practice Address - Fax:706-733-1168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017993208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGPA913Medicaid
GA=========OtherTRICARE
GA=========OtherTRICARE