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General NPI Number Information
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NPI Number | 1659675445
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Entity Type | Organization
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Legal Business Name | SOUTHERN PLASTIC & RECONSTRUCTIVE SURGICAL INSTITITUTE
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Dates
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Enumeration Date | 01/07/2011
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Last Update Date | 01/07/2011
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Provider Practice Location Address
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Address Line | 4601 CAROTHERS PKWY SUITE 285
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City | FRANKLIN
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State | TN
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Zip | 37067-5976
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Country | US
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Telephone | 615-791-9090
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Fax | 615-791-8393
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Provider Business Mailing Address
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Address Line | 4601 CAROTHERS PKWY SUITE 285
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City | FRANKLIN
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State | TN
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Zip | 37067-5976
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Country | US
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Telephone | 615-791-9090
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Fax | 615-791-8393
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. NATHAN RAY BROUGHT
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Credential | DO
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Telephone | 615-791-9090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 2115
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License Number State | TN
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