Provider Demographics
NPI:1144212846
Name:ADVANCED AESTHETICS, P.C
Entity type:Organization
Organization Name:ADVANCED AESTHETICS, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRECERTIFICATION COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-883-1405
Mailing Address - Street 1:874 W LANIER AVE
Mailing Address - Street 2:ONE PRESTIGE PARK SUITE 100
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1511
Mailing Address - Country:US
Mailing Address - Phone:770-461-4000
Mailing Address - Fax:770-461-2790
Practice Address - Street 1:874 W LANIER AVE
Practice Address - Street 2:ONE PRESTIGE PARK SUITE 100
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1511
Practice Address - Country:US
Practice Address - Phone:770-461-4000
Practice Address - Fax:770-461-2790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty