DR. EDWARD SCOTT GRONKA (NPI# 1306838099) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306838099 |
| Entity Type | Individual |
| Full Name | DR. EDWARD SCOTT GRONKA |
| Credential | M.D. |
| Practice Address |
874 W Lanier Ave One Prestige Park Suite 100 Fayetteville GA 30214-1511 |
| Practice Telephone | 7704614000 |
| Practice Fax Number | 7704612790 |
| Mailing Telephone | 7704614000 |
| Mailing Fax Number | 7704612790 |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2007-08-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208200000X | Plastic Surgery | 035431 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 00502433A | 05 |
| Street Address |
874 W LANIER AVE ONE PRESTIGE PARK SUITE 100 |
| City | FAYETTEVILLE |
| State | GA |
| Zip Code | 30214-1511 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962441709 | Advanced Aesthetics PC | Clinic/Center | 874 W Lanier Ave, Ste 110, Fayetteville, GA 30214-7659 | 2006-06-06 |
| 1588656367 | Paul David Feldman | Plastic Surgery | 874 W Lanier Ave, Suite 100, Fayetteville, GA 30214-1511 | 2005-08-18 |
| 1891787586 | Joseph Raniere,jr | Plastic Surgery | 874 W Lanier Ave, One Prestige Park Suite 100, Fayetteville, GA 30214-1511 | 2005-08-18 |
| 1144212846 | Advanced Aesthetics, P.c | Plastic Surgery | 874 W Lanier Ave, One Prestige Park Suite 100, Fayetteville, GA 30214-1511 | 2005-08-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548872468 | Phyllis Kelly Wood | Nurse Practitioner | 217 Banks Rd, Suite 31, Fayetteville, GA 30214 | 2020-08-21 |
| 1073139317 | Tyisha Salter Scott | Counselor | 110 Habersham Drive, Suite 142, Fayetteville, GA 30214 | 2020-06-23 |
| 1194341412 | Camille Franncine Bolton | Physical Therapist | 500 Floy Farr Parkway, Suite 303, Fayetteville, GA 30214 | 2020-06-23 |
| 1205465895 | Gillian Vaughan Heard | Physician Assistant | 1275 Ga-54 #201, Fayetteville, GA 30214 | 2020-04-06 |
| 1881234557 | Peach Fits,inc | Mastectomy Fitter | 285 Glynn Street South, Suites 102 and 104, Fayetteville, GA 30214 | 2020-01-10 |
| 1255981072 | Delta Healthcare Providers | Clinic/Center | 1275 W Lanier Ave, #200, Fayetteville, GA 30214 | 2019-09-13 |
| 1861965592 | Hierarchy for Wellness | Specialist | 805 S Glynn St Bldg 127 142, Fayetteville, GA 30214 | 2019-01-04 |
| 1356810634 | Fayette Dental Group PC | Clinic/Center | 720 W Lanier Ave, Fayetteville, GA 30214 | 2018-11-16 |
| 1891263299 | Mattie Mae Farmer Clark | Specialist/Technologist, Other | Piedmont Fayette Hospital, 1255 Highway 54 West, Fayetteville, GA 30214 | 2018-11-05 |
| 1093293607 | Allyson Holland | Pharmacist | 880 Highway 85 South, Fayetteville, GA 30214 | 2018-08-06 |
| Find all providers in zip 30214 | ||||
| Taxonomy Code | 208200000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Plastic Surgery |
| A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Plastic Surgery, 2007. http://www.abplsurg.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Plastic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710291299 | The Center for Plastic Surgery, Plc | Plastic Surgery | 3733 N Business Dr Ste 102, Fayetteville, AR 72703-5286 | 2010-07-27 |
| 1245567833 | Carolina Plastic Surgery of Fayetteville PC | Plastic Surgery | 2153 Valleygate Dr Ste 103, Fayetteville, NC 28304-3667 | 2009-11-03 |
| 1962648980 | R. Douglas Vanderpool | Plastic Surgery | 2552 E. Joyce Blvd., Suite B, Fayetteville, AR 72703-4553 | 2008-12-22 |
| 1255498887 | Stephen Mitchell Herring | Plastic Surgery | 516 Beaumont Rd, Fayetteville, NC 28304-4443 | 2007-01-02 |
| 1548342702 | Saira Saini | Plastic Surgery | 2153 Valleygate Dr., Suite 103 Carolina Plastic Surgery, Fayetteville, NC 28304 | 2006-10-19 |
| 1740245893 | David Heath Stacey | Plastic Surgery | 137 W Van Asche Loop, Fayetteville, AR 72703-4999 | 2006-04-20 |
| 1760733448 | Truffles Vein Center, LLC | Plastic Surgery | 874 Lanier Ave W, Suite 120, Fayetteville, GA 30214-7662 | 2012-09-21 |
| 1801190731 | Denis F Branson Md Professional Corporation | Plastic Surgery | 7000 E Genesee St, Building E, Fayetteville, NY 13066-1131 | 2011-01-06 |
| 1396057758 | Northwest Arkansas Center for Plastic Surgery, Ltd. | Plastic Surgery | 137 W Van Asche Loop, Fayetteville, AR 72703 | 2010-07-13 |
| 1760527220 | Cape Fear Plastic Surgery Pa | Plastic Surgery | 516 Beaumont Rd, Fayetteville, NC 28304-4443 | 2007-02-21 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 30214 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.