Aesthetic Laser & Surgery Facility

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

136-113 Issued in GA

Legal business name

AESTHETIC LASER & SURGERY FACILITY

Practice address

416 Gordon Ave
Thomasville, GA 31792-6644

Phone

(229) 228-7200

Fax

(229) 228-5193

NPI assigned

Nov 10, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. G. Courtney Houston, M.D.NPI 1295805570

Title

Medical Director

Phone

(229) 228-7200

Specialties & licenses 1

Addresses

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 1841361052. Details of each certification follow.

• CCN 11C0001089 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 11C0001089

Legal name

AESTHETIC LASER & SURG FACILITY

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Oct 28, 1996

Last certification

Apr 10, 2019

Ownership / control type

Proprietary

Facility address

416 Gordon Ave.
Thomasville, GA 31792

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.

• G. Courtney Houston, M.D.

  • Plastic and Reconstructive Surgery Physician
  • Thomasville, GA
  • NPI 1295805570
  NPD (past) Authorized official

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

{
    "created_epoch": "1163116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1841361052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 GORDON AVE",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317926644",
            "telephone_number": "229-228-7200",
            "fax_number": "229-228-5193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 GORDON AVE",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317926644",
            "telephone_number": "229-228-7200",
            "fax_number": "229-228-5193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AESTHETIC LASER & SURGERY FACILITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOUSTON",
        "authorized_official_first_name": "G. COURTNEY",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "229-228-7200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "136-113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Henry Ackerman, DMD
• Tomesha Adams, MEDICAL ASSISTANT
• Angela Renee Addison, FNP-C
• Adk Thomasville Operator, LLC (Thomasville Nursing and Rehab Center)
• Advanced Medical Group LLC (Thomas Drug Store)
• Aesthetic Plastic Surgery Center
• Aesthetica Surgery Center, LLC
• Albany Area Primary Health Care, Inc (Rural HIV Model Thomasville)
• Charles Alvin Alday Jr., PA
• William Ralph Alday, CRNA

• Ambulatory Surgical Clinic/Center in Thomasville, GA
• Providers in Thomasville, GA by specialty
• Ambulatory Surgical Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.