Organization
SCULPTRX INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CASSAUNDRA GRAVES MD (CREDENTIALING)
(678) 613-2971
Entity
Organization
Contact information
Practice address
125 TOWNPARK DR NW, STE 300, KENNESAW, GA 30144-5803
(770) 450-0846
Mailing address
125 TOWNPARK DR NW, STE 300, KENNESAW, GA 30144-5803
(770) 450-0846
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
34119
GA
Other
Enumeration date
08/25/2016
Last updated
08/25/2016
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