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NPI 1063604791
● Active Type 2 · Organization
Renaissance Plastic Surgery
Specialist · MacOn, GA · NPI 1063604791
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Enumerated 2007 · 19 years on NPI
Renaissance Plastic Surgery is 1 of 1,876 specialist organizations in Georgia.
NPI age
19 years
Enumerated 2007-08-16
Primary specialty
Specialist
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Stuart
Administrator
Last NPPES update
2007-08-16
Source: CMS NPPES provider record
How this organization compares
Across 1876 active specialist providers in Georgia.
NPI age
19 years
≈ at median (19 yr)
Practice locations
1
0 secondary on file
NPI lifetime · 2007 → 2007
2007-08 Enumerated in NPPES
2007
2007
Where they practice
Primary practice location
4030 Riverside Park Blvd
MacOn, GA 312101365
📞 4784742200 fax 4783140740
Mailing address
4030 Riverside Park Blvd
MacOn, GA 312101365
📞 4784742200 fax 4783140740
Authorized official
Kathy Stuart
Administrator
📞 4784742200
Other providers sharing this address
3 individual providers use this same primary NPPES address. Address matching does not prove employment or organizational affiliation.
Practice context
Shared NPPES address.
3 individual providers use this primary address. This does not prove employment or affiliation.
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How to verify this organization
Confirm the NPI on NPPES. The CMS registry is the system of record. Open NPPES →
Verify the organization is in good standing. Cross-check with the state's business registration and any applicable licensing boards.
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Provider record updated 2007-08-16
· Source: CMS NPPES bulk export. Check the linked CMS record for the latest source entry.
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NPI listing is not proof of active licensure or payer enrollment.
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