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General NPI Number Information
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NPI Number | 1801761291
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Entity Type | Organization
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Legal Business Name | PINNACLE PLASTIC SURGERY ASSOCIATES LLC
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Dates
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Enumeration Date | 10/07/2025
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 813 TOWNE PARK DRIVE SUITE 100
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City | RINCON
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State | GA
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Zip | 31326
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Country | US
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Telephone | 843-815-6699
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Fax | 843-815-6695
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Provider Business Mailing Address
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Address Line | 7 MALLETT WAY
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City | BLUFFTON
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State | SC
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Zip | 29910-6064
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Country | US
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Telephone | 843-815-6699
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Fax | 843-815-6695
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Authorized Official
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Title or Position | OWNER
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Name | DR. AUDREY KLENKE
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Credential | M.D
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Telephone | 843-815-6699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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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 |
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License Number State |
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