Organization
RENAISSANCE PLASTIC SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHY STUART (ADMINISTRATOR)
(478) 474-2200
Entity
Organization
Contact information
Practice address
4030 RIVERSIDE PARK BLVD, MACON, GA 31210-1365
(478) 474-2200
(478) 314-0740
Mailing address
4030 RIVERSIDE PARK BLVD, MACON, GA 31210-1365
(478) 474-2200
(478) 314-0740
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
08/16/2007
Last updated
08/16/2007
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