Healthcare Provider Details

I. General information

NPI: 1669246815
Provider Name (Legal Business Name): GREENSBORO PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 GREEN VALLEY RD
GREENSBORO NC
27408-7041
US

IV. Provider business mailing address

802 GREEN VALLEY RD
GREENSBORO NC
27408-7041
US

V. Phone/Fax

Practice location:
  • Phone: 540-460-3625
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: COLLIER PACE
Title or Position: CEO
Credential: MD
Phone: 540-460-3625