Provider Demographics
NPI:1720263742
Name:GEORGIA PLASTIC SURGERY SPECIALISTS PC
Entity Type:Organization
Organization Name:GEORGIA PLASTIC SURGERY SPECIALISTS PC
Other - Org Name:ATLANTIC CENTER FOR PLASTIC & COSMETIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MORGAN
Authorized Official - Last Name:DAVOUDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-418-1234
Mailing Address - Street 1:3855 PLEASANT HILL RD
Mailing Address - Street 2:SUITE 460
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1407
Mailing Address - Country:US
Mailing Address - Phone:770-418-1234
Mailing Address - Fax:770-817-1110
Practice Address - Street 1:3855 PLEASANT HILL RD
Practice Address - Street 2:SUITE 460
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1407
Practice Address - Country:US
Practice Address - Phone:770-418-1234
Practice Address - Fax:770-817-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045060174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7519Medicare PIN