Healthcare Provider Details

I. General information

NPI: 1689001067
Provider Name (Legal Business Name): CLINTON PLASTIC SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7191 CAHABA VALLEY RD 200
BIRMINGHAM AL
35242-6402
US

IV. Provider business mailing address

7191 CAHABA VALLEY RD 200
BIRMINGHAM AL
35242-6402
US

V. Phone/Fax

Practice location:
  • Phone: 205-408-9787
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number10939
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number10939
License Number StateAL

VIII. Authorized Official

Name: DR. MICHAEL S CLINTON
Title or Position: OWNER
Credential: MD
Phone: 205-408-9787