Healthcare Provider Details

I. General information

NPI: 1316014681
Provider Name (Legal Business Name): PLASTIC SURGERY OF TUSCALOOSA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1847 COMMONS NORTH DR STE A
TUSCALOOSA AL
35406-3700
US

IV. Provider business mailing address

1847 COMMONS NORTH DR STE A
TUSCALOOSA AL
35406-3700
US

V. Phone/Fax

Practice location:
  • Phone: 205-349-0049
  • Fax: 659-734-2003
Mailing address:
  • Phone: 205-349-0049
  • Fax: 659-734-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MARQUIS HESTER
Title or Position: INSURANCE
Credential:
Phone: 205-349-0049