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Organization

ADVANCED AESTHETICS PC

Active
Parent organization
ADVANCED AESTHETICS, PC
Other names
Advanced Aesthetics PC
Organization subpart
Yes

Provider details

NPI number
Legal business name
ADVANCED AESTHETICS, PC
Authorized official
MRS. DIANE RODRIGUEZ (OFFICE MANAGER)
(770) 461-4000
Entity
Organization

Contact information

Practice address
874 W LANIER AVE, STE 110, FAYETTEVILLE, GA 30214-7659
(770) 461-4000
(770) 461-2790
Mailing address
874 W LANIER AVE, STE 100, FAYETTEVILLE, GA 30214-7659
(770) 461-4000
(770) 461-2790

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary

Other

Enumeration date
06/06/2006
Last updated
08/23/2012
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