Spa Medical LLC

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

Legal business name

SPA MEDICAL LLC

Doing business as

Aesthetic Center for Plastic Surgery

Practice address

455 Plum St
Macon, GA 31201-3368

Phone

(478) 743-2209

NPI assigned

Aug 5, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Kenneth Earl Harper, MD

Title

Owner

Phone

(478) 743-2472

Specialties & licenses 1

Addresses

Other names 1

• Aesthetic Center for Plastic Surgery Doing business as

Locations

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

{
    "created_epoch": "1596585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601942400000",
    "number": "1427668342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 PLUM ST",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312013368",
            "telephone_number": "478-743-2209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 PLUM ST",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312013368",
            "telephone_number": "478-743-2209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPA MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-05",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A",
        "authorized_official_last_name": "HARPER",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "EARL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "478-743-2472",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aesthetic Center for Plastic Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Plastic and Reconstructive Surgery Physician in Macon, GA
• Providers in Macon, 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 Oct 6, 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.