Provider Demographics
NPI:1902219058
Name:GEORGIA PLASTIC SURGERY & RECONSTRUCTIVE CARE, PC
Entity Type:Organization
Organization Name:GEORGIA PLASTIC SURGERY & RECONSTRUCTIVE CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PIOTR
Authorized Official - Middle Name:P
Authorized Official - Last Name:SKOWRONSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-635-0330
Mailing Address - Street 1:2151B WEST SPRING STREET
Mailing Address - Street 2:SUITE 240
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655
Mailing Address - Country:US
Mailing Address - Phone:678-635-0330
Mailing Address - Fax:770-602-1296
Practice Address - Street 1:2151-B W SPRING ST
Practice Address - Street 2:SUITE 240
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-3115
Practice Address - Country:US
Practice Address - Phone:678-635-0330
Practice Address - Fax:770-602-1296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-06
Last Update Date:2015-06-08
Deactivation Date:2015-05-27
Deactivation Code:
Reactivation Date:2015-06-04
Provider Licenses
StateLicense IDTaxonomies
GA065617208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty