Healthcare Provider Details

I. General information

NPI: 1659675445
Provider Name (Legal Business Name): SOUTHERN PLASTIC & RECONSTRUCTIVE SURGICAL INSTITITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 CAROTHERS PKWY SUITE 285
FRANKLIN TN
37067-5976
US

IV. Provider business mailing address

4601 CAROTHERS PKWY SUITE 285
FRANKLIN TN
37067-5976
US

V. Phone/Fax

Practice location:
  • Phone: 615-791-9090
  • Fax: 615-791-8393
Mailing address:
  • Phone: 615-791-9090
  • Fax: 615-791-8393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number2115
License Number StateTN

VIII. Authorized Official

Name: DR. NATHAN RAY BROUGHT
Title or Position: OWNER/PHYSICIAN
Credential: DO
Phone: 615-791-9090