| NPI | 1669976213 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETTYE J CHASTAIN Supervisor 423-763-4543 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: TN 38782) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TN 55433) |
| 2086S0105X Surgery Surgery of the Hand (Licence: TN 26787) | |
| 2086S0105X Surgery Surgery of the Hand (Licence: TN 28796) | |
| 2086S0105X Surgery Surgery of the Hand (Licence: TN 36502) | |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: TN 28796) | |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: TN 55433) | |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: TN 36502) | |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2019-01-28 |