Organization Active NPI

Breast Body Beauty LLC

  • Plastic and Reconstructive Surgery Physician
  • Smyrna, GA
National Provider Identifier
1669927075
Registry record updated Jun 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
Legal business name
BREAST BODY BEAUTY LLC
Practice address
1300 Hawthorne Ave SE
Smyrna, GA 30080-2136
Phone
(678) 540-1144
Fax
(678) 540-1166
NPI assigned
Aug 16, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2025

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

Authorized official

Name
Dr. Aisha McKnight Baron, MD
Title
President
Phone
(678) 540-1144

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2086S0122X Primary

Addresses

Primary practice location

1300 Hawthorne Ave SE
Smyrna, GA 30080-2136

Mailing address

PO Box 128
Bellaire, TX 77402-0128
Phone (281) 833-3330

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160906001016 GA Part B Supplier - Clinic/Group Practice 5496041253 Receives reassigned benefits from 1 practitioner
Practice locations: Smyrna, GA

National Provider Directory

National Provider Directory

Locations

1300 Hawthorne Ave SE
Smyrna, GA 30080
Phone (678) 540-1144

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": "1471305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750032000000",
    "number": "1669927075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 128",
            "city": "BELLAIRE",
            "state": "TX",
            "postal_code": "774020128",
            "telephone_number": "281-833-3330",
            "fax_number": "281-833-3323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 HAWTHORNE AVE SE",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300802136",
            "telephone_number": "678-540-1144",
            "fax_number": "678-540-1166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREAST BODY BEAUTY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-16",
        "last_updated": "2025-06-16",
        "certification_date": "2025-06-16",
        "status": "A",
        "authorized_official_last_name": "BARON",
        "authorized_official_first_name": "AISHA",
        "authorized_official_middle_name": "MCKNIGHT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-540-1144",
        "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": []
}

Other providers in Smyrna, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2025; 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.