Basic Information
| Provider Information | |||||||||
| NPI: | 1770520587 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AESTHETIC SPECIALTY CENTRE, PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | AESTHETIC SPECIALTY CENTRE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1825 OLD ALABAMA RD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | ROSWELL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300762258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703939000 | ||||||||
| FaxNumber: | 7703939006 | ||||||||
| Practice Location | |||||||||
| Address1: | 1825 OLD ALABAMA RD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | ROSWELL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300762258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703939000 | ||||||||
| FaxNumber: | 7703939006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 09/10/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | YUNE | ||||||||
| AuthorizedOfficialFirstName: | MARC | ||||||||
| AuthorizedOfficialMiddleName: | EAN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7703939000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 09/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.