Organization
RENAISSANCE RECONSTRUCTION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA CASTRO (ADMINISTRATOR)
(478) 621-4213
Entity
Organization
Contact information
Practice address
3379 OSBORNE PL, MACON, GA 31204-1901
(478) 474-2200
(478) 314-0740
Mailing address
PO BOX 27435, MACON, GA 31221-7435
(478) 474-2200
(478) 314-0740
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Enumeration date
11/08/2022
Last updated
11/08/2022
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