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NPI Profile for SOUTHERN CRESCENT PLASTIC SURGERY PC in STOCKBRIDGE, GA.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Plastic and Reconstructive Surgery |
2086S0122X | 02 | Physician/General Surgery |
| NPI # | 1841573458 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 09/21/2011 | |
| Last updated | 09/21/2011 - About 15 years ago | |
| Sole proprietor 1 | Not specified | |
| Identifiers | Not Available | |
| Hospital affiliation(s) | Not Available |
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SOUTHERN CRESCENT PLASTIC SURGERY, PC