Organization
SOUTHERN INDIANA AESTHETIC AND PLASTIC SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS LOGAN JACKSON M.D. (OWNER)
(812) 376-8997
Entity
Organization
Contact information
Practice address
2450 N PARK DR STE B, COLUMBUS, IN 47203-2292
(812) 376-8997
(812) 373-5323
Mailing address
2450 N PARK DR STE B, COLUMBUS, IN 47203-2292
(812) 376-8997
(812) 373-5323
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
01046379A
IN
Other
Enumeration date
08/31/2006
Last updated
12/04/2012
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