Buckhead Plastic Surgery

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

045278 Issued in GA

Legal business name

BUCKHEAD PLASTIC SURGERY

Practice address

4684 Roswell Rd
Suite B
Atlanta, GA 30342-3074

Phone

(404) 367-9005

Fax

(678) 240-4188

NPI assigned

Oct 14, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Alan Norman Larsen, M.D.NPI 1871633362

Title

President

Phone

(404) 367-9005

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Alan N Larsen, M.D.

  • Plastic Surgery Physician
  • Atlanta, GA
  • NPI 1871633362
  Medicare reassignment NPD Authorized official
• Ana Carolyn Bonilla, MSN, FNP-C

  • Family Nurse Practitioner
  • Alpharetta, GA
  • NPI 1851190722
  NPD (past)

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

{
    "created_epoch": "1287014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472083200000",
    "number": "1427368315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4684 ROSWELL RD",
            "address_2": "SUITE B",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303423074",
            "telephone_number": "404-367-9005",
            "fax_number": "678-240-4188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4684 ROSWELL RD",
            "address_2": "SUITE B",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303423074",
            "telephone_number": "404-367-9005",
            "fax_number": "678-240-4188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUCKHEAD PLASTIC SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-14",
        "last_updated": "2016-08-25",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "NORMAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-367-9005",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "GA",
            "license": "045278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Buckhead Medical LLC Dba Northalke Medical Group
• Buckhead Medical Solutions
• Buckhead Mohs Surgical Center LLC
• Buckhead Optics LLC (Pearle Vision Lenox)
• Buckhead Periodontics, P.C.
• Buckhead Podiatry Associates LLC
• Buckhead Primary Care, LLC
• Buckhead Smile Center, P.C.
• Buckhead Smiles Cosmetic and Family Dentistry LLC
• Buckhead Speech Specialists, Inc.

• Plastic Surgery Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Plastic Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.