National Provider Identifier Database

MARIETTA PLASTIC SURGERY
Plastic and Reconstructive Surgery


Contact Information

MARIETTA PLASTIC SURGERY
149 TOWNE LAKE PKWY
WOODSTOCK, GA30188-4859
Phone: 678-494-2380
Fax: 678-494-2379
Website:
Specialty Taxonomy Code
* Plastic and Reconstructive Surgery 2086S0122X

* Indicates primary specialty

NPI Profile & details for MARIETTA PLASTIC SURGERY

NPI Number 1164746244
Legal business name
LBN
MARIETTA PLASTIC SURGERY
Authorized official DONNA BOCKHORST - (PRACTICE ADMIN)
Entity Organization
Organization subpart No
Enumeration date 03/18/2010
Last updated 03/18/2010 - About 16 years ago
Sole proprietor1 Not specified
Identifiers n/a

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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