# PLASTIC AND RECONSTRUCTIVE SURGERY PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215167580
- **Authorized official:** LAURIE P WEBB DELEGATED OFFICIAL (INSURANCE MANAGER)
- **Authorized official phone:** (423) 328-9000

## Contact information

- **Practice address:** 1303 SUNSET DR STE 5, JOHNSON CITY, TN 37604-7905
- **Practice address phone:** (423) 328-9000
- **Practice address fax:** (423) 328-9007
- **Mailing address:** 1303 SUNSET DR STE 5, JOHNSON CITY, TN 37604-7905
- **Mailing address phone:** (423) 328-9000
- **Mailing address fax:** (423) 328-9007

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 173000000X | Legal Medicine | MD0000025117 | TN | Yes |

## Other

- **Enumeration date:** 07/21/2009
- **Last updated:** 11/13/2019