Provider Demographics
NPI:1245399260
Name:NORTH GEORGIA PLASTIC SURGERY LLC
Entity Type:Organization
Organization Name:NORTH GEORGIA PLASTIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:ADCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-648-5525
Mailing Address - Street 1:251 N LYERLY ST
Mailing Address - Street 2:STE 200
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2728
Mailing Address - Country:US
Mailing Address - Phone:423-648-5525
Mailing Address - Fax:423-648-5240
Practice Address - Street 1:102 GROSS CRESCENT CIR
Practice Address - Street 2:SUITE 501
Practice Address - City:FT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-3600
Practice Address - Country:US
Practice Address - Phone:423-648-5525
Practice Address - Fax:423-648-5240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E92318Medicare UPIN
GA24BCBTPMedicare ID - Type Unspecified
TN3730614Medicare ID - Type Unspecified