Provider Demographics
NPI:1518168616
Name:PLASTIC SURGERY OF NASHVILLE
Entity Type:Organization
Organization Name:PLASTIC SURGERY OF NASHVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:STANFORD
Authorized Official - Last Name:BLALOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-386-9030
Mailing Address - Street 1:4535 HARDING PIKE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2120
Mailing Address - Country:US
Mailing Address - Phone:615-386-9030
Mailing Address - Fax:
Practice Address - Street 1:4535 HARDING PIKE
Practice Address - Street 2:SUITE 304
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2120
Practice Address - Country:US
Practice Address - Phone:615-386-9030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000016583174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3015935Medicare ID - Type Unspecified
TNA97993Medicare UPIN
TN3339317Medicare ID - Type Unspecified