Provider Demographics
NPI:1902650211
Name:EXCLUSIVELY FACES COSMETIC SURGERY AND MEDISPA PC
Entity Type:Organization
Organization Name:EXCLUSIVELY FACES COSMETIC SURGERY AND MEDISPA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:KAREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-857-3211
Mailing Address - Street 1:PO BOX 3250
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22604-2450
Mailing Address - Country:US
Mailing Address - Phone:540-678-3588
Mailing Address - Fax:540-678-9025
Practice Address - Street 1:20 FRANCIS WAY STE 300
Practice Address - Street 2:
Practice Address - City:SHARPSBURG
Practice Address - State:GA
Practice Address - Zip Code:30277-3589
Practice Address - Country:US
Practice Address - Phone:678-857-3211
Practice Address - Fax:678-857-3212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty