Organization Active NPI

Stephen Lober Plastic Surgery, PC

  • Plastic Surgery Physician
  • Athens, GA
National Provider Identifier
1073032579
Registry record updated Apr 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
Legal business name
STEPHEN LOBER PLASTIC SURGERY, PC
Practice address
2325 Prince Ave
Athens, GA 30606-6003
Phone
(706) 369-8440
Fax
(706) 850-3411
NPI assigned
Sep 15, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2021

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

Authorized official

Name
Dr. Stephen Bruce Lober, MDNPI 1366584781
Title
Owner
Phone
(706) 369-8440

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208200000X Primary
Medical Specialty Clinic/Center 261QM2500X 033386 GA

Addresses

Primary practice location

2325 Prince Ave
Athens, GA 30606-6003

Mailing address

2325 Prince Ave
Athens, GA 30606-6003
Phone (706) 369-8440

Other identifiers 2

IdentifierTypeStateIssuer
003199243AMedicaidGA
000465638BMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180725002335 GA Part B Supplier - Clinic/Group Practice 7618224411 Receives reassigned benefits from 1 practitioner
Practice locations: Athens, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D1029229Stephen Lober Plastic Surgery, PC2325 Prince Avenue, Athens, GA 30606Certificate of waiverDec 12, 2026

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1505433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618358400000",
    "number": "1073032579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2325 PRINCE AVE",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306066003",
            "telephone_number": "706-369-8440",
            "fax_number": "706-850-3411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2325 PRINCE AVE",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306066003",
            "telephone_number": "706-369-8440",
            "fax_number": "706-850-3411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHEN LOBER PLASTIC SURGERY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-15",
        "last_updated": "2021-04-14",
        "certification_date": "2021-04-14",
        "status": "A",
        "authorized_official_last_name": "LOBER",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "BRUCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-369-8440",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "GA",
            "license": "033386",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003199243A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000465638B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Athens, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.