Healthcare Provider Details

I. General information

NPI: 1831102078
Provider Name (Legal Business Name): THE PLASTIC SURGERY GROUP OF MEMPHIS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 HUMPHREYS CTR STE 100
MEMPHIS TN
38120-2352
US

IV. Provider business mailing address

8110 N BROTHER BLVD STE 200
BARTLETT TN
38133-2760
US

V. Phone/Fax

Practice location:
  • Phone: 901-761-9030
  • Fax: 901-761-9591
Mailing address:
  • Phone: 901-373-2459
  • Fax: 901-373-4511

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. ERIC W GIBSON
Title or Position: CFO
Credential:
Phone: 901-373-2459