Provider Demographics
NPI:1699759035
Name:WILLIAMS PLASTIC AND RECONSTRUCTIVE SURGERY,PC
Entity type:Organization
Organization Name:WILLIAMS PLASTIC AND RECONSTRUCTIVE SURGERY,PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KLANCY
Authorized Official - Middle Name:LAUREN
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-278-2700
Mailing Address - Street 1:1506 PROFESSIONAL COURT
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720
Mailing Address - Country:US
Mailing Address - Phone:706-278-2700
Mailing Address - Fax:706-278-3444
Practice Address - Street 1:1506 PROFESSIONAL COURT
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720
Practice Address - Country:US
Practice Address - Phone:706-278-2700
Practice Address - Fax:706-278-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAASTC001175261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00186938OtherRAILROAD MEDICARE
GAP00186938OtherRAILROAD MEDICARE