Provider Demographics
NPI:1356214696
Name:PINNACLE PLASTIC SURGERY ASSOCIATES LLC
Entity type:Organization
Organization Name:PINNACLE PLASTIC SURGERY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLENKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-815-6699
Mailing Address - Street 1:7 MALLETT WAY
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6064
Mailing Address - Country:US
Mailing Address - Phone:843-815-6699
Mailing Address - Fax:843-815-6695
Practice Address - Street 1:812 TOWNE PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-9365
Practice Address - Country:US
Practice Address - Phone:843-815-6699
Practice Address - Fax:843-815-6695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty