# AVENUE AESTHETIC AND RECONSTRUCTIVE SURGERY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Avenue Aesthetic and Reconstructive Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336912021
- **Authorized official:** JESSICA BAVANI (OFFICE MANAGER)
- **Authorized official phone:** (706) 363-0256

## Contact information

- **Practice address:** 489 N MILLEDGE AVE, ATHENS, GA 30601-3807
- **Practice address phone:** (706) 363-0256
- **Practice address fax:** (706) 622-4360
- **Mailing address:** 489 N MILLEDGE AVE, ATHENS, GA 30601-3807
- **Mailing address phone:** (706) 363-0256
- **Mailing address fax:** (706) 622-4360

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/03/2023
- **Last updated:** 11/03/2023