Provider Demographics
NPI:1588934046
Name:GEORGIA PLASTIC SURGERY
Entity type:Organization
Organization Name:GEORGIA PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LINCENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-730-8222
Mailing Address - Street 1:1 GLENLAKE PKWY NE
Mailing Address - Street 2:SUITE 950
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3448
Mailing Address - Country:US
Mailing Address - Phone:770-730-8222
Mailing Address - Fax:678-527-1281
Practice Address - Street 1:1 GLENLAKE PKWY NE
Practice Address - Street 2:SUITE 950
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3448
Practice Address - Country:US
Practice Address - Phone:770-730-8222
Practice Address - Fax:678-527-1281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032233208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAB48305Medicare UPIN