Provider Demographics
NPI:1083245161
Name:CHARLOTTESVILLE PLASTIC SURGERY
Entity Type:Organization
Organization Name:CHARLOTTESVILLE PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RHETT
Authorized Official - Middle Name:NICHOLSON
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:434-227-5333
Mailing Address - Street 1:1410 INCARNATION DR STE 205A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-5708
Mailing Address - Country:US
Mailing Address - Phone:434-227-5333
Mailing Address - Fax:434-483-5040
Practice Address - Street 1:1410 INCARNATION DR STE 205A
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-5708
Practice Address - Country:US
Practice Address - Phone:434-227-5333
Practice Address - Fax:434-483-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty