Provider Demographics
NPI:1861124646
Name:MAXFACESURGERY PLLC
Entity type:Organization
Organization Name:MAXFACESURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-208-9064
Mailing Address - Street 1:125 WITHERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-7816
Mailing Address - Country:US
Mailing Address - Phone:470-223-7292
Mailing Address - Fax:888-919-3051
Practice Address - Street 1:125 WITHERIDGE DR
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-7816
Practice Address - Country:US
Practice Address - Phone:470-223-7292
Practice Address - Fax:888-919-3051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty