Organization
PLASTIC AND RECONSTRUCTIVE SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURIE P WEBB DELEGATED OFFICIAL (INSURANCE MANAGER)
(423) 328-9000
Entity
Organization
Contact information
Practice address
1303 SUNSET DR STE 5, JOHNSON CITY, TN 37604-7905
(423) 328-9000
(423) 328-9007
Mailing address
1303 SUNSET DR STE 5, JOHNSON CITY, TN 37604-7905
(423) 328-9000
(423) 328-9007
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
MD0000025117
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3081165
—
TN
Enumeration date
07/21/2009
Last updated
11/13/2019
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