| NPI | 1811090475 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN ANDUSON FAGG President 336-765-8620 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 20000119979) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NC 200001225739) |
| 208200000X Plastic Surgery (Licence: NC 200001205450) | |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2020-08-22 |