Healthcare Provider Details

I. General information

NPI: 1669976213
Provider Name (Legal Business Name): THE PLASTIC SURGERY GROUP,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1949 GUNBARREL RD STE 303
CHATTANOOGA TN
37421-3188
US

IV. Provider business mailing address

901 RIVERFRONT PARKWAY STE 100
CHATTANOOGA TN
37402-2102
US

V. Phone/Fax

Practice location:
  • Phone: 423-756-7134
  • Fax: 423-763-4571
Mailing address:
  • Phone: 423-756-7134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number36502
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number36502
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number28796
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number55433
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number55433
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number26787
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number28796
License Number StateTN
# 8
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number38782
License Number StateTN

VIII. Authorized Official

Name: MRS. BETTYE J CHASTAIN
Title or Position: SUPERVISOR
Credential:
Phone: 423-763-4543