Provider Demographics
NPI:1487080537
Name:THE GEORGIA CENTER FOR BODY PLASTIC SURGERY
Entity type:Organization
Organization Name:THE GEORGIA CENTER FOR BODY PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-364-3223
Mailing Address - Street 1:902 PONDER PLACE CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3184
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:902 PONDER PLACE CT
Practice Address - Street 2:SUITE 1
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3184
Practice Address - Country:US
Practice Address - Phone:706-210-2625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty