Provider Demographics
NPI:1912370602
Name:AESTHETIC SURGERY OF CHARLOTTE PLLC
Entity Type:Organization
Organization Name:AESTHETIC SURGERY OF CHARLOTTE PLLC
Other - Org Name:AUGENSTEIN AESTHETIC SURGERY CENTER, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:AUGENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-837-1150
Mailing Address - Street 1:11835 SOUTHMORE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4466
Mailing Address - Country:US
Mailing Address - Phone:704-837-1150
Mailing Address - Fax:704-837-1156
Practice Address - Street 1:11835 SOUTHMORE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4466
Practice Address - Country:US
Practice Address - Phone:704-837-1150
Practice Address - Fax:704-837-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-00490208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
024C4MOtherBCBS
NC1912370602Medicaid
NC024C4MOtherBCNC