Provider Demographics
NPI:1265941413
Name:SENTINEL PLASTIC SURGERY LLC
Entity type:Organization
Organization Name:SENTINEL PLASTIC SURGERY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:BENOIST
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-718-1326
Mailing Address - Street 1:123 WEAVER RD STE B
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-3155
Mailing Address - Country:US
Mailing Address - Phone:561-718-1326
Mailing Address - Fax:
Practice Address - Street 1:123 WEAVER RD STE B
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-3155
Practice Address - Country:US
Practice Address - Phone:706-439-6486
Practice Address - Fax:706-745-7271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA070745208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty