Healthcare Provider Details

I. General information

NPI: 1578834644
Provider Name (Legal Business Name): THAXTON PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 CAPITOL ST STE 100
CHARLESTON WV
25301-1204
US

IV. Provider business mailing address

505 CAPITOL ST STE 100
CHARLESTON WV
25301-1204
US

V. Phone/Fax

Practice location:
  • Phone: 304-925-8949
  • Fax: 304-925-8953
Mailing address:
  • Phone: 304-925-8949
  • Fax: 304-925-8953

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: DR. JEFFREY NORMAN THAXTON
Title or Position: MEMBER
Credential: MD
Phone: 304-925-8949