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General NPI Number Information
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NPI Number | 1275716680
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Entity Type | Organization
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Legal Business Name | MIDDLE TENNESSEE PLASTIC SURGERY, P.C.
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 10/13/2015
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Provider Practice Location Address
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Address Line | 820 MEDICAL CENTER PARKWAY
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City | MURFREESBORO
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State | TN
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Zip | 37129
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Country | US
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Telephone | 615-599-1966
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Fax | 615-599-9536
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Provider Business Mailing Address
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Address Line | 820 MEDICAL CENTER PARKWAY
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City | MURFREESBORO
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State | TN
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Zip | 37129
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Country | US
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Telephone | 615-599-1966
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Fax | 615-599-9536
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID S MARTIN
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Credential | MD
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Telephone | 615-907-1015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2082S0105X
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Taxonomy Name | Surgery of the Hand (Plastic Surgery) Physician
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License Number | 26589
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 26589
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License Number State | TN
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