Organization
PLASTIC SURGERY CENTER OF NC INC
Active
Parent organization
PLASTIC SURGERY CENTER OF NC INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PLASTIC SURGERY CENTER OF NC INC
Authorized official
DR. JOHN ANDERSON FAGG MD (PRESIDENT)
(336) 765-8620
Entity
Organization
Contact information
Practice address
2901 MAPLEWOOD AVE, WINSTON SALEM, NC 27103-4009
(336) 765-8620
(336) 768-6236
Mailing address
2901 MAPLEWOOD AVE, WINSTON SALEM, NC 27103-4009
(336) 765-8620
(336) 768-6236
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
200001349669
NC
2086S0122X
Plastic and Reconstructive Surgery Physician
200001355455
NC
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
200001376220
NC
Other
Enumeration date
10/04/2006
Last updated
08/01/2007
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