Provider Demographics
NPI:1356338313
Name:PLOSKA, PHILIP G (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:G
Last Name:PLOSKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 N PARK PL STE 101
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7237
Mailing Address - Country:US
Mailing Address - Phone:770-892-0273
Mailing Address - Fax:470-878-1495
Practice Address - Street 1:135 N PARK PL STE 101
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7237
Practice Address - Country:US
Practice Address - Phone:770-892-0273
Practice Address - Fax:470-878-1495
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036848207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000544926EMedicaid
GA000544926GMedicaid
GA000544926JMedicaid
GA000544926JMedicaid
GA000544926EMedicaid