Provider Demographics
NPI:1770520587
Name:AESTHETIC SPECIALTY CENTRE, PC
Entity type:Organization
Organization Name:AESTHETIC SPECIALTY CENTRE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:EAN
Authorized Official - Last Name:YUNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-393-9000
Mailing Address - Street 1:1825 OLD ALABAMA RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-2258
Mailing Address - Country:US
Mailing Address - Phone:770-393-9000
Mailing Address - Fax:770-393-9006
Practice Address - Street 1:1825 OLD ALABAMA RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-2258
Practice Address - Country:US
Practice Address - Phone:770-393-9000
Practice Address - Fax:770-393-9006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP4546Medicare ID - Type Unspecified