Provider Demographics
NPI:1942090071
Name:NORTHSIDE PLASTIC SURGERY ASSOCIATES LLC
Entity type:Organization
Organization Name:NORTHSIDE PLASTIC SURGERY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KSHITIJ
Authorized Official - Middle Name:VIPIN
Authorized Official - Last Name:MAJMUNDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-475-3146
Mailing Address - Street 1:11681 HAYNES BRIDGE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-2713
Mailing Address - Country:US
Mailing Address - Phone:770-475-3146
Mailing Address - Fax:678-215-0688
Practice Address - Street 1:11681 HAYNES BRIDGE RD STE 200
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-2713
Practice Address - Country:US
Practice Address - Phone:770-475-3146
Practice Address - Fax:678-215-0688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty