Provider Demographics
NPI:1952836835
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:678-407-4988
Mailing Address - Street 1:631 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3367
Mailing Address - Country:US
Mailing Address - Phone:678-407-4988
Mailing Address - Fax:706-407-4972
Practice Address - Street 1:631 PROFESSIONAL DR
Practice Address - Street 2:SUITE 240
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3367
Practice Address - Country:US
Practice Address - Phone:678-407-4988
Practice Address - Fax:706-407-4972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA65617208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty