Provider Demographics
NPI:1730422346
Name:PLASTIC SURGERY ASSOCIATES
Entity type:Organization
Organization Name:PLASTIC SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:H
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-794-6643
Mailing Address - Street 1:3450 ACWORTH DUE WEST RD
Mailing Address - Street 2:BLDG 200 STE 220
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1078
Mailing Address - Country:US
Mailing Address - Phone:770-794-6643
Mailing Address - Fax:770-794-6683
Practice Address - Street 1:3450 ACWORTH DUE WEST RD
Practice Address - Street 2:BLDG 200 STE 220
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1078
Practice Address - Country:US
Practice Address - Phone:770-794-6643
Practice Address - Fax:770-794-6683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-02
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty