Provider Demographics
NPI:1780968115
Name:PREMIER AESTHETICS
Entity type:Organization
Organization Name:PREMIER AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:678-689-6485
Mailing Address - Street 1:5404 HILLANDALE PARK CT
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-8803
Mailing Address - Country:US
Mailing Address - Phone:678-418-6990
Mailing Address - Fax:678-418-6986
Practice Address - Street 1:5404 HILLANDALE PARK CT
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-8803
Practice Address - Country:US
Practice Address - Phone:678-418-6990
Practice Address - Fax:678-418-6986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA08518174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty