Organization
WEST SIDE PLASTIC SURGERY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VETRA A GIPSON M.D. (OWNER)
(404) 805-0646
Entity
Organization
Contact information
Practice address
960 JOHNSON FERRY RD N.E., SUITE 336, ATLANTA, GA 30342
(404) 805-5535
(866) 935-5995
Mailing address
4480 S COBB DR SE STE H, BOX 323, SMYRNA, GA 30080-6984
(404) 805-5535
(866) 935-5995
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
50518
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000963102B
—
GA
Enumeration date
05/29/2007
Last updated
04/11/2011
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