Organization
FAYETTE PLASTICSURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH RANIERE JR. M.D. (VICE PRESIDENT)
(770) 461-4000
Entity
Organization
Contact information
Practice address
874 LANIER AVE W, SUITE 100, FAYETTEVILLE, GA 30214-7662
(770) 461-4000
(770) 603-7040
Mailing address
874 LANIER AVE W, SUITE 100, FAYETTEVILLE, GA 30214-7662
(770) 461-4000
(770) 603-7040
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
12056659
GA
Other
Enumeration date
01/15/2013
Last updated
01/15/2013
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