ADVANCED AESTHETICS PC (NPI# 1962441709) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962441709 |
| Entity Type | Organization |
| Organization Name | ADVANCED AESTHETICS PC |
| Other Organization Name | ADVANCED AESTHETICS PC |
| Practice Address |
874 W Lanier Ave Ste 110 Fayetteville GA 30214-7659 |
| Mailing Address |
874 W Lanier Ave Ste 100 Fayetteville GA 30214-7659 |
| Practice Telephone | 7704614000 |
| Practice Fax Number | 7704612790 |
| Mailing Telephone | 7704614000 |
| Mailing Fax Number | 7704612790 |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2012-08-23 |
| Authorized Official Name | MRS. DIANE RODRIGUEZ (OFFICE MANAGER) |
| Authorized Official Telephone | 7704614000 |
| Is Organization Subpart | Y |
| Parent Organization Name | ADVANCED AESTHETICS, PC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Advanced Aesthetics PC | Doing Business As Name - Organization |
| Street Address |
874 W LANIER AVE STE 110 |
| City | FAYETTEVILLE |
| State | GA |
| Zip Code | 30214-7659 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306838099 | Edward Scott Gronka | Plastic Surgery | 874 W Lanier Ave, One Prestige Park Suite 100, Fayetteville, GA 30214-1511 | 2005-08-18 |
| 1588656367 | Paul David Feldman | Plastic Surgery | 874 W Lanier Ave, Suite 100, Fayetteville, GA 30214-1511 | 2005-08-18 |
| 1891787586 | Joseph Raniere,jr | Plastic Surgery | 874 W Lanier Ave, One Prestige Park Suite 100, Fayetteville, GA 30214-1511 | 2005-08-18 |
| 1144212846 | Advanced Aesthetics, P.c | Plastic Surgery | 874 W Lanier Ave, One Prestige Park Suite 100, Fayetteville, GA 30214-1511 | 2005-08-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548872468 | Phyllis Kelly Wood | Nurse Practitioner | 217 Banks Rd, Suite 31, Fayetteville, GA 30214 | 2020-08-21 |
| 1073139317 | Tyisha Salter Scott | Counselor | 110 Habersham Drive, Suite 142, Fayetteville, GA 30214 | 2020-06-23 |
| 1194341412 | Camille Franncine Bolton | Physical Therapist | 500 Floy Farr Parkway, Suite 303, Fayetteville, GA 30214 | 2020-06-23 |
| 1205465895 | Gillian Vaughan Heard | Physician Assistant | 1275 Ga-54 #201, Fayetteville, GA 30214 | 2020-04-06 |
| 1881234557 | Peach Fits,inc | Mastectomy Fitter | 285 Glynn Street South, Suites 102 and 104, Fayetteville, GA 30214 | 2020-01-10 |
| 1255981072 | Delta Healthcare Providers | Clinic/Center | 1275 W Lanier Ave, #200, Fayetteville, GA 30214 | 2019-09-13 |
| 1861965592 | Hierarchy for Wellness | Specialist | 805 S Glynn St Bldg 127 142, Fayetteville, GA 30214 | 2019-01-04 |
| 1356810634 | Fayette Dental Group PC | Clinic/Center | 720 W Lanier Ave, Fayetteville, GA 30214 | 2018-11-16 |
| 1891263299 | Mattie Mae Farmer Clark | Specialist/Technologist, Other | Piedmont Fayette Hospital, 1255 Highway 54 West, Fayetteville, GA 30214 | 2018-11-05 |
| 1093293607 | Allyson Holland | Pharmacist | 880 Highway 85 South, Fayetteville, GA 30214 | 2018-08-06 |
| Find all providers in zip 30214 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477178879 | Surgcenter of Fayetteville, LLC | Clinic/Center | 1905 E Mission Blvd Ste 5, Fayetteville, AR 72703-3129 | 2020-06-11 |
| 1750905618 | Rsps Fayetteville Asc Lllp | Clinic/Center | 874 Lanier Ave W Ste 270, Fayetteville, GA 30214-7617 | 2020-06-05 |
| 1396298139 | Resurgens Fayette Surgery Center, LLC | Clinic/Center | 1336 Highway 54 W Bldg 400, Fayetteville, GA 30214-4535 | 2016-07-28 |
| 1447630876 | Ortho Atlanta Surgery Center of Fayetteville | Clinic/Center | 1265 Highway 54 W Ste 103, Fayetteville, GA 30214-4537 | 2015-06-01 |
| 1801196050 | Agcny East LLC | Clinic/Center | Northeast Medical Building Condominium, Suite 308, Fayetteville, NY 13066-6638 | 2010-10-21 |
| 1265679674 | Georgia Urology Fayette Asc | Clinic/Center | 140 Carnegie Pl, Suite 108, Fayetteville, GA 30214-7913 | 2009-01-07 |
| 1093907339 | Taylor Surgery Center, LLC | Clinic/Center | 3733 N Business Dr Ste 101, Fayetteville, AR 72703-5286 | 2007-08-10 |
| 1386737021 | Arkansas Outpatient Eye Surgery LLC | Clinic/Center | 3689 N Steele Blvd, Fayetteville, AR 72703-5347 | 2006-10-02 |
| 1033154364 | Paula Pons Physician LLC | Clinic/Center | 4206 Medical Center Dr Ste 203, Fayetteville, NY 13066 | 2006-06-19 |
| 1285622845 | Physicians' Surgery Center of Fayetteville, LLC | Clinic/Center | 3733 N Business Dr, Suite #101, Fayetteville, AR 72703-5203 | 2005-10-07 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 30214 |
Please comment or provide details below to improve the information on ADVANCED AESTHETICS PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.