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RENAISSANCE PLASTIC SURGERY
NPI 1063604791
Specialist in Macon, GA

Active since August 16, 2007CLIA 11D1023871 · Waiver
4030 RIVERSIDE PARK BLVD, MACON, GA 31210(478) 474-2200(478) 314-0740 Get Directions Write a Review

NPPES record last updated: August 16, 2007. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Renaissance Plastic Surgery NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RENAISSANCE PLASTIC SURGERY (NPI 1063604791) is a healthcare organization registered as a specialist in Macon, Georgia and active in the NPI registry since August 2007. The organization holds a CLIA Waiver certificate valid through March 28, 2028 and lists Kathy Stuart, Administrator, as its authorized official.

NPPES Registry Identity

NPI1063604791
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameRENAISSANCE PLASTIC SURGERY
Location Address4030 RIVERSIDE PARK BLVDMacon, GA 31210-1365
Mailing Address4030 Riverside Park BlvdMacon, GA 31210-1365 · (478) 474-2200 · Fax (478) 314-0740
Phone(478) 474-2200
Fax(478) 314-0740
Organization SubpartNo
Authorized OfficialKathy StuartAdministrator · (478) 474-2200
Enumeration DateAugust 16, 2007
✔ NPI 1063604791 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
Definition

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

4030 RIVERSIDE PARK BLVD, Macon, GA 31210
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Other Identifiers 1

Medicare PINGRP4616GA

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D1023871

Renaissance Surgical Center LLC · Macon, GA
Active · expires Mar 28, 2028
CLIA Number11D1023871
Laboratory TypeAmbulatory Surgery Center
Certificate Effective DateMarch 29, 2026
Certificate Expiration DateMarch 28, 2028
Laboratory DirectorRoy Powell Jr
Laboratory Phone(478) 477-6425
Laboratory LocationRenaissance Surgical Center LLC4030 Riverside Park Boulevard, Macon, GA 31210
CLIA data matches this NPI record on: Address
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. PAUL JOHN SYRIBEYS M.D.
Plastic Surgery
4030 RIVERSIDE PARK BLVD
MACON, GA 31210
Bibb County (478) 474-2200
MAXIMUS ANESTHESIA SERVICES LLC
Nurse Anesthetist, Certified Registered
4030 RIVERSIDE PARK BLVD
MACON, GA 31210
Bibb County (478) 474-2200
RENAISSANCE SURGICAL CENTRE, LLC
Clinic/Center (Ambulatory Surgical)
4030 RIVERSIDE PARK BLVD
MACON, GA 31210
Bibb County (478) 474-2200
RENAISSANCE MAH
Surgery (Plastic and Reconstructive Surgery)
4030 RIVERSIDE PARK BLVD
MACON, GA 31210
Bibb County (502) 468-8534
DR. CHRISTOPHER L MCLENDON MD
Surgery (Plastic and Reconstructive Surgery)
4030 RIVERSIDE PARK BLVD
MACON, GA 31210
Bibb County (478) 474-2200
DR. ROY POWELL MD
Plastic Surgery
4030 RIVERSIDE PARK BLVD
MACON, GA 31210
Bibb County (478) 474-2200

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Renaissance Plastic Surgery's NPI number?

The NPI number for Renaissance Plastic Surgery is 1063604791. It was assigned to this organization in the NPPES registry on August 16, 2007.

Where is Renaissance Plastic Surgery located?

Renaissance Plastic Surgery is located at 4030 Riverside Park Blvd, Macon, GA 31210. The listed phone number is (478) 474-2200.

What is Renaissance Plastic Surgery's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Does Renaissance Plastic Surgery hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D1023871) is associated with this NPI, valid through March 28, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Renaissance Plastic Surgery accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama and Ambetter of North Carolina and 1 other insurer list Renaissance Plastic Surgery as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Renaissance Plastic Surgery was last updated on August 16, 2007. NPI Profile syncs with the weekly NPPES data releases published by CMS.