Aesthetic Specialty Centre, PC
Organization Active NPI Specialist · Roswell, GA
NPI 1770520587 · NPPES record last updated Sep 10, 2020
Key facts
- NPI
- 1770520587
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- Legal business name
- AESTHETIC SPECIALTY CENTRE, PC
- Practice address
- 1825 Old Alabama Rd
Suite 201
Roswell, GA 30076-2258 - Phone
- (770) 393-9000
- Fax
- (770) 393-9006
- NPI assigned
- Jun 1, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Marc Ean Yune, MD
- Title
- Owner
- Phone
- (770) 393-9000
Practitioners 3
-
Marc Ean Yune, MD
-
Olivia Paige Burchett, PA-C
-
Tracey Michele Yune, FNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060421000178 | GA | Part B Supplier - Clinic/Group Practice | 0840200747 |
Receives reassigned benefits from 2 practitioners Practice locations: Greensboro, GA; Roswell, GA |
National Provider Directory
Locations
2001 Linger Longer Rd
Greensboro, GA 30642
Phone (770) 393-9000
1825 Old Alabama Rd
Ste 201
Roswell, GA 30076
Phone (770) 393-9000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | Yes |
Addresses
Primary practice location
1825 Old Alabama Rd
Suite 201
Roswell, GA 30076-2258
Mailing address
1825 Old Alabama Rd
Suite 201
Roswell, GA 30076-2258
Phone (770) 393-9000
Other practice location 1
2001 Linger Longer Rd
Greensboro, GA 30642-4917
Phone (706) 467-6500
Other names
- Aesthetic Specialty Centre
Other providers in Roswell, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.