Healthcare Provider Details

I. General information

NPI: 1780897272
Provider Name (Legal Business Name): HILTON HEAD ISLAND PLASTIC SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 BILL FRIES DR ISLAND MEDICAL PLAZA, BLDG E
HILTON HEAD ISLAND SC
29926-2730
US

IV. Provider business mailing address

35 BILL FRIES DR ISLAND MEDICAL PLAZA, BLDG E
HILTON HEAD ISLAND SC
29926-2730
US

V. Phone/Fax

Practice location:
  • Phone: 843-681-4088
  • Fax: 843-689-3742
Mailing address:
  • Phone: 843-681-4088
  • Fax: 843-689-3742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number8695
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number8695
License Number StateSC

VIII. Authorized Official

Name: DR. ROBERT ABEL LAUGHLIN
Title or Position: OWNER
Credential: MD
Phone: 843-681-4088