NPIMap

Organization Active NPI

Fayette Plasticsurgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Fayetteville, GA
National Provider Identifier
1639416365
Registry record updated Jan 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
12056659 Issued in GA
Legal business name
FAYETTE PLASTICSURGERY CENTER LLC
Practice address
874 Lanier Ave W
Suite 100
Fayetteville, GA 30214-7662
Phone
(770) 461-4000
Fax
(770) 603-7040
NPI assigned
Jan 15, 2013
Last updated
Jan 15, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2013

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

Authorized official

Name
Joseph Raniere Jr., M.D.
Title
Vice President
Phone
(770) 461-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 12056659 GA Primary

Addresses

Primary practice location

874 Lanier Ave W
Suite 100
Fayetteville, GA 30214-7662

Mailing address

874 Lanier Ave W
Suite 100
Fayetteville, GA 30214-7662
Phone (770) 461-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639416365. Details of each certification follow.

Ambulatory surgical center certification: CCN 11C0001061

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
FAYETTE PLASTIC SURGERY CENTER, LLC
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Aug 8, 1994
Last certification
Apr 20, 2017
Ownership / control type
Proprietary
Facility address
874 West Lanier Avenue, Suite 100
Fayetteville, GA 30214

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, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1358208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358208000000",
    "number": "1639416365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "874 LANIER AVE W",
            "address_2": "SUITE 100",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147662",
            "telephone_number": "770-461-4000",
            "fax_number": "770-603-7040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "874 LANIER AVE W",
            "address_2": "SUITE 100",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147662",
            "telephone_number": "770-461-4000",
            "fax_number": "770-603-7040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTE PLASTICSURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-15",
        "last_updated": "2013-01-15",
        "status": "A",
        "authorized_official_last_name": "RANIERE",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "770-461-4000",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "12056659",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, GA

Sources for this page

Verify at the official NPI Registry.