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Organization

CORDRAY PLASTIC SURGERY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. TRACY L CORDRAY M.D. (OWNER/PHYSICIAN)
(843) 718-2334
Entity
Organization

Contact information

Practice address
2093 HENRY TECKLENBURG DR STE 304, CHARLESTON, SC 29414-5743
(843) 718-2334
(843) 277-2067
Mailing address
44 FOLLY ROAD BLVD STE C, CHARLESTON, SC 29407-7559
(843) 718-2334
(843) 277-2067

Taxonomy

Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
22185
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1346432614
SOLE PROPRIETOR NPI-TYPE 1
01
22185
STATE LICENSE
05
30236309
SC
Enumeration date
02/22/2017
Last updated
08/28/2025
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