MARIETTA PLASTIC SURGERY NPI 1164746244

NPI Information

  • NPI: 1164746244
  • Provider Name: MARIETTA PLASTIC SURGERY
  • Classification: Surgery - 2086S0122X
  • Specialization: Plastic and Reconstructive Surgery
  • Entity Type: Organization
  • CLIA Number: 11D0954036
  • Address: 149 TOWNE LAKE PKWY
    WOODSTOCK, GA
    ZIP 30188
  • Phone: (678) 494-2380

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NPI Details

MARIETTA PLASTIC SURGERY is a plastic and reconstructive surgery surgery in Woodstock, GA. The provider is a surgeon who specializes in plastic and reconstructive surgery. MARIETTA PLASTIC SURGERY NPI is 1164746244. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

149 TOWNE LAKE PKWY
WOODSTOCK, GA
ZIP 30188-859
Phone: (678) 494-2380
Fax: (678) 494-2379

The provider's authorized official is Donna Marie Bockhorst .
The authorized official title is Practice Admin and has the following contact phone number (770) 425-0118.

The CLIA number assigned to this NPI record is 11D0954036 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/18/2010 and was last updated on 3/18/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12086S0122XSurgeryPlastic and Reconstructive SurgeryGEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1GRP 626MEDICARE PINGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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