Organization
AESTHETIC LASER & SURGERY FACILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. G. COURTNEY HOUSTON M.D. (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
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
136-113
GA
Other
Enumeration date
11/10/2006
Last updated
08/22/2020
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