NPIMap

Organization Active NPI

Advanced Aesthetics PC

  • Ambulatory Surgical Clinic/Center
  • Fayetteville, GA
National Provider Identifier
1962441709
Registry record updated Aug 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
ADVANCED AESTHETICS PC
Doing business as
Advanced Aesthetics PC
Practice address
874 W Lanier Ave
Ste 110
Fayetteville, GA 30214-7659
Phone
(770) 461-4000
Fax
(770) 461-2790
NPI assigned
Jun 6, 2006
Last updated
Aug 23, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
ADVANCED AESTHETICS, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 23, 2012

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

Authorized official

Name
Mrs. Diane Rodriguez
Title
Office Manager
Phone
(770) 461-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

874 W Lanier Ave
Ste 110
Fayetteville, GA 30214-7659

Mailing address

874 W Lanier Ave
Ste 100
Fayetteville, GA 30214-7659
Phone (770) 461-4000

Other names 1

  • Advanced Aesthetics PC Doing business as

National Provider Directory

National Provider Directory
Part of
Advanced Aesthetics PC

Locations

170 Bastille Way
Ste B
Fayetteville, GA 30214
Phone (770) 461-4000

874 Lanier Ave W
Ste 110
Fayetteville, GA 30214
Phone (770) 461-4000

499 Arrowhead Blvd
Jonesboro, GA 30236
Phone (770) 603-6000

Practitioners & affiliated clinicians

Practitioners 6

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": "1149552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345680000000",
    "number": "1962441709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "874 W LANIER AVE",
            "address_2": "STE 100",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147659",
            "telephone_number": "770-461-4000",
            "fax_number": "770-461-2790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "874 W LANIER AVE",
            "address_2": "STE 110",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147659",
            "telephone_number": "770-461-4000",
            "fax_number": "770-461-2790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED AESTHETICS PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADVANCED AESTHETICS, PC",
        "enumeration_date": "2006-06-06",
        "last_updated": "2012-08-23",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "770-461-4000",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Aesthetics PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayetteville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 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.