Provider Demographics
NPI:1417451048
Name:THE PLASTIC SURGERY GROUP,PC
Entity Type:Organization
Organization Name:THE PLASTIC SURGERY GROUP,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:BETTYE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHASTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-763-4543
Mailing Address - Street 1:901 RIVERFRONT PARKWAY
Mailing Address - Street 2:STE 100
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-2102
Mailing Address - Country:US
Mailing Address - Phone:423-756-7134
Mailing Address - Fax:
Practice Address - Street 1:1949 GUNBARREL RD STE 303
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3188
Practice Address - Country:US
Practice Address - Phone:423-756-7134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier