NPIMap

Organization Active NPI

West Side Plastic Surgery, Inc

  • Plastic and Reconstructive Surgery Physician
  • Atlanta, GA
National Provider Identifier
1730380775
Registry record updated Apr 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
50518 Issued in GA
Legal business name
WEST SIDE PLASTIC SURGERY, INC
Practice address
960 Johnson Ferry Rd N.E.
Suite 336
Atlanta, GA 30342
Phone
(404) 805-5535
Fax
(866) 935-5995
NPI assigned
May 29, 2007
Last updated
Apr 11, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2011

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

Authorized official

Name
Dr. Vetra A Gipson, M.D.NPI 1528068061
Title
Owner
Phone
(404) 805-0646

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2086S0122X 50518 GA Primary

Addresses

Primary practice location

960 Johnson Ferry Rd N.E.
Suite 336
Atlanta, GA 30342

Mailing address

4480 S Cobb Dr SE Ste H
Box 323
Smyrna, GA 30080-6984
Phone (404) 805-5535

Other identifiers 1

IdentifierTypeStateIssuer
000963102BMedicaidGA

National Provider Directory

National Provider Directory

Locations

1680 Mulkey Rd
Ste B
Austell, GA 30106
Phone (770) 948-8421

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": "1180396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302480000000",
    "number": "1730380775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4480 S COBB DR SE STE H",
            "address_2": "BOX 323",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300806984",
            "telephone_number": "404-805-5535",
            "fax_number": "866-935-5995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 JOHNSON FERRY RD N.E.",
            "address_2": "SUITE 336",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30342",
            "telephone_number": "404-805-5535",
            "fax_number": "866-935-5995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST SIDE PLASTIC SURGERY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-29",
        "last_updated": "2011-04-11",
        "status": "A",
        "authorized_official_last_name": "GIPSON",
        "authorized_official_first_name": "VETRA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-805-0646",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "GA",
            "license": "50518",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000963102B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2011; 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.