Marietta Plastic Surgery

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

Legal business name

MARIETTA PLASTIC SURGERY

Practice address

149 Towne Lake Pkwy
Woodstock, GA 30188-4859

Phone

(678) 494-2380

Fax

(678) 494-2379

NPI assigned

Mar 18, 2010

Last updated

Mar 18, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Donna Marie Bockhorst

Title

Practice Admin

Phone

(770) 425-0118

Specialties & licenses 1

Addresses

Tax ID family

Marietta Plastic Surgery2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Marietta Plastic Surgery

  • Ambulatory Surgical Clinic/Center
  • Marietta, GA
  • NPI 1417116567
  NPD tax ID

Locations

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

{
    "created_epoch": "1268870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268870400000",
    "number": "1164746244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "149 TOWNE LAKE PKWY",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301884859",
            "telephone_number": "678-494-2380",
            "fax_number": "678-494-2379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 TOWNE LAKE PKWY",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301884859",
            "telephone_number": "678-494-2380",
            "fax_number": "678-494-2379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIETTA PLASTIC SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-18",
        "last_updated": "2010-03-18",
        "status": "A",
        "authorized_official_last_name": "BOCKHORST",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRACTICE ADMIN",
        "authorized_official_telephone_number": "770-425-0118"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Leon Manrique, MD
• Joseph Benedict Malabanan Maralit, PT
• Cassandra L Marchant, DC
• Marietta Eye Clinic, PA
• Marietta Eye Optical Inc
• Susan Marini
• Jonathan Griffin Marquess, PHARMD, CDE
• Jonathan William Marquess, PHARMD
• Daisy Lauren Marrero
• Stephanie Ann Marshall, M.S., S/T

• Plastic and Reconstructive Surgery Physician in Woodstock, GA
• Providers in Woodstock, GA by specialty
• Plastic and Reconstructive Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2010; 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.