Provider Demographics
NPI:1659675445
Name:SOUTHERN PLASTIC & RECONSTRUCTIVE SURGICAL INSTITITUTE
Entity Type:Organization
Organization Name:SOUTHERN PLASTIC & RECONSTRUCTIVE SURGICAL INSTITITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BROUGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:615-791-9090
Mailing Address - Street 1:4601 CAROTHERS PKWY
Mailing Address - Street 2:SUITE 285
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-5976
Mailing Address - Country:US
Mailing Address - Phone:615-791-9090
Mailing Address - Fax:615-791-8393
Practice Address - Street 1:4601 CAROTHERS PKWY
Practice Address - Street 2:SUITE 285
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5976
Practice Address - Country:US
Practice Address - Phone:615-791-9090
Practice Address - Fax:615-791-8393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21152086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty