Organization
SOUTHEASTERN PLASTIC SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENSON EL TIMMONS IV MD (PRESIDENT)
(704) 866-4005
Entity
Organization
Contact information
Practice address
649 N NEW HOPE RD, GASTONIA, NC 28054-7424
(704) 866-4005
(704) 866-0450
Mailing address
649 N NEW HOPE RD, GASTONIA, NC 28054-7424
(704) 866-4005
(704) 866-0450
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0269X
BCBS
NC
05
—
890269X
—
NC
Enumeration date
01/24/2006
Last updated
08/19/2008
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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