| NPI | 1407724164 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIRANDA BOWEN Credentialing 615-504-1984 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery |
| Enumeration Date | 2025-10-24 |
| Last Update Date | 2026-06-19 |