National Provider Identifier Database

SOUTHEASTERN AESTHETIC AND RECONSTRUCTIVE SURGERY
Plastic and Reconstructive Surgery


Contact Information

SOUTHEASTERN AESTHETIC AND RECONSTRUCTIVE SURGERY
155 GREENVILLE ST
NEWNAN, GA30263-2630
Phone: 404-642-7722
Fax:
Website:
Specialty Taxonomy Code
* Plastic and Reconstructive Surgery 2086S0122X

* Indicates primary specialty

NPI Profile & details for SOUTHEASTERN AESTHETIC AND RECONSTRUCTIVE SURGERY

NPI Number 1093255044
Legal business name
LBN
SOUTHEASTERN AESTHETIC AND RECONSTRUCTIVE SURGERY
Authorized official FREDERICK DURDEN - (PHYSICIAN)
Entity Organization
Organization subpart No
Enumeration date 02/24/2017
Last updated 02/24/2017 - About 9 years ago
Sole proprietor1 Not specified
Identifiers
  • GA License #: 65539

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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