Provider Demographics
NPI:1356917199
Name:DALTON PLASTIC SURGERY
Entity type:Organization
Organization Name:DALTON PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INS CLERK
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-226-3311
Mailing Address - Street 1:1501 BROADRICK DR STE 1
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-3014
Mailing Address - Country:US
Mailing Address - Phone:706-226-3311
Mailing Address - Fax:706-275-8723
Practice Address - Street 1:1501 BROADRICK DR STE 1
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3014
Practice Address - Country:US
Practice Address - Phone:706-226-3311
Practice Address - Fax:706-275-8723
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DALTON PLASTIC SURGERY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty