Provider Demographics
NPI:1063251668
Name:ESJ AESTHETICS LLC
Entity type:Organization
Organization Name:ESJ AESTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:770-466-4700
Mailing Address - Street 1:1730 MOUNT VERNON RD STE A
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4245
Mailing Address - Country:US
Mailing Address - Phone:770-466-4700
Mailing Address - Fax:
Practice Address - Street 1:1730 MOUNT VERNON RD STE A
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-4245
Practice Address - Country:US
Practice Address - Phone:770-466-4700
Practice Address - Fax:678-737-1760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty