Organization
PLASTIC SURGERY CENTER, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANA GORMAN (VICE PRES- OFFICE MANAGER)
(601) 373-3730
Entity
Organization
Contact information
Practice address
1920 CHADWICK DR, SUITE 108, JACKSON, MS 39204-3471
(601) 373-3730
Mailing address
1920 CHADWICK DR, SUITE 108, JACKSON, MS 39204-3471
(601) 373-3730
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
08261
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05959573
—
MS
Enumeration date
02/27/2007
Last updated
04/20/2008
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