Southern Crescent Plastic Surgery ASC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

035432 Issued in GA

Legal business name

SOUTHERN CRESCENT PLASTIC SURGERY ASC

Practice address

919 Eagles Landing Pkwy
Stockbridge, GA 30281-5011

Phone

(770) 389-0446

Fax

(770) 389-3530

NPI assigned

Jan 19, 2007

Organization subpart

No

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

Authorized official

Name

Alice Gross, NURSE RNFA

Title

Administrator

Phone

(770) 389-0446

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329436800000",
    "number": "1942353115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "919 EAGLES LANDING PKWY",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302815011",
            "telephone_number": "770-389-0446",
            "fax_number": "770-389-3530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 EAGLES LANDING PKWY",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302815011",
            "telephone_number": "770-389-0446",
            "fax_number": "770-389-3530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CRESCENT PLASTIC SURGERY ASC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2012-02-17",
        "status": "A",
        "authorized_official_last_name": "GROSS",
        "authorized_official_first_name": "ALICE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "770-389-0446",
        "authorized_official_credential": "NURSE RNFA"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "035432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00762572A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southern Crescent ENT, P.C.
• Southern Crescent Medical Center, LLC
• Southern Crescent Nephrology, PC
• Southern Crescent Pain Management LLC
• Southern Crescent Pediatrics PC
• Southern Crescent Plastic Surgery, PC
• Southern Crescent Women'S Health Specialists
• Southern Crescent Womens Health Specialists at Eagle'S Landing
• Southern Medical Clinic LLC
• Southern Medical Clinic, LLC

• Ambulatory Surgical Clinic/Center in Stockbridge, GA
• Providers in Stockbridge, 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 Feb 17, 2012; 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.