Healthcare Provider Details

I. General information

NPI: 1093717845
Provider Name (Legal Business Name): NASHVILLE PLASTIC SURGERY INSTITUTE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 21ST AVE S STE 100
NASHVILLE TN
37212-4354
US

IV. Provider business mailing address

2020 21ST AVE S STE 100
NASHVILLE TN
37212-4354
US

V. Phone/Fax

Practice location:
  • Phone: 615-932-7700
  • Fax: 615-932-7707
Mailing address:
  • Phone: 615-932-7700
  • Fax: 615-932-7707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number13577
License Number StateTN

VIII. Authorized Official

Name: MISS KATHY BYRD
Title or Position: OFFICE MANAGER
Credential:
Phone: 615-292-7708