Healthcare Provider Details

I. General information

NPI: 1245399260
Provider Name (Legal Business Name): NORTH GEORGIA PLASTIC SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 01/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 GROSS CRESCENT CIR SUITE 501
FT OGLETHORPE GA
30742-3600
US

IV. Provider business mailing address

251 N LYERLY ST STE 200
CHATTANOOGA TN
37404-2728
US

V. Phone/Fax

Practice location:
  • Phone: 423-648-5525
  • Fax: 423-648-5240
Mailing address:
  • Phone: 423-648-5525
  • Fax: 423-648-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID W ADCOCK
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 423-648-5525