Provider Demographics
NPI:1609837442
Name:THE PLASTIC SURGERY GROUP, P.C. (A GEORGIA CORPORATION)
Entity Type:Organization
Organization Name:THE PLASTIC SURGERY GROUP, P.C. (A GEORGIA CORPORATION)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAULEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-756-7134
Mailing Address - Street 1:979 E 3RD ST
Mailing Address - Street 2:SUITE C920
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2136
Mailing Address - Country:US
Mailing Address - Phone:423-756-7134
Mailing Address - Fax:423-763-4571
Practice Address - Street 1:4700 BATTLEFIELD PKWY
Practice Address - Street 2:SUITE 360
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-5166
Practice Address - Country:US
Practice Address - Phone:423-756-7134
Practice Address - Fax:423-763-4571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2011-04-08
Deactivation Date:2010-08-04
Deactivation Code:
Reactivation Date:2011-03-31
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5045250001Medicare NSC