Organization
SOUTHERN CRESCENT PLASTIC SURGERY ASC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALICE GROSS NURSE RNFA (ADMINISTRATOR)
(770) 389-0446
Entity
Organization
Contact information
Practice address
919 EAGLES LANDING PKWY, STOCKBRIDGE, GA 30281-5011
(770) 389-0446
(770) 389-3530
Mailing address
919 EAGLES LANDING PKWY, STOCKBRIDGE, GA 30281-5011
(770) 389-0446
(770) 389-3530
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
035432
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00762572A
—
GA
Enumeration date
01/19/2007
Last updated
02/17/2012
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