Northeast Georgia Plastic Surgery Associates, Plastic Surgery Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

069-037 Issued in GA

Legal business name

NORTHEAST GEORGIA PLASTIC SURGERY ASSOCIATES, PLASTIC SURGERY CENTER

Practice address

1296 Sims St
Suite B
Gainesville, GA 30501-3850

Phone

(770) 534-1856

Fax

(770) 531-0355

NPI assigned

Jul 22, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Samuel W. Richwine Jr., M. D.

Title

Medical Director

Phone

(770) 534-1856

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1023039385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1296 SIMS ST",
            "address_2": "SUITE B",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013850",
            "telephone_number": "770-534-1856",
            "fax_number": "770-531-0355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1296 SIMS ST",
            "address_2": "SUITE B",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013850",
            "telephone_number": "770-534-1856",
            "fax_number": "770-531-0355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST GEORGIA PLASTIC SURGERY ASSOCIATES, PLASTIC SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2020-08-22",
        "certification_date": "2020-07-15",
        "status": "A",
        "authorized_official_last_name": "RICHWINE",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "770-534-1856",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M. D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "069-037",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Northeast Georgia Physicians Group Urgent Care LLC
• Northeast Georgia Physicians Group-Urgent Care, LLC
• Northeast Georgia Physicians Group, Inc.
• Northeast Georgia Physicians Group, Inc.
• Northeast Georgia Plastic Surgery
• Northeast Georgia Podiatry LLC
• Northeast Georgia Rehabilitation Hospital LLC
• Northeast Georgia Specialty Group LLC
• Northeast Georgia Speech Center, Inc.
• Northeast Georgia Surgery Center

• All providers in Gainesville, GA
• Ambulatory Surgical Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.