Organization
AESTHETIC PLASTIC SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE COURTNEY HOUSTON MD (MEDICAL DIRECTOR)
(229) 228-7200
Entity
Organization
Contact information
Practice address
416 GORDON AVE, THOMASVILLE, GA 31792-6644
(229) 228-7200
(229) 228-5193
Mailing address
416 GORDON AVE, THOMASVILLE, GA 31792-6644
(229) 228-7200
(229) 228-5193
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
18675
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003112787A
—
GA
01
—
238212HO
BLUE CROSS BLUE SHIELD
—
Enumeration date
08/22/2011
Last updated
10/30/2013
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