Provider Demographics
NPI:1508556358
Name:COOPER SCURRY FACIAL PLASTIC SURGERY CENTER PLLC
Entity Type:Organization
Organization Name:COOPER SCURRY FACIAL PLASTIC SURGERY CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:COOPER
Authorized Official - Last Name:SCURRY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:336-671-1679
Mailing Address - Street 1:855 BETHESDA RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3026
Mailing Address - Country:US
Mailing Address - Phone:336-671-1679
Mailing Address - Fax:
Practice Address - Street 1:855 BETHESDA RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3026
Practice Address - Country:US
Practice Address - Phone:336-671-1679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty