MEDICARE: PLASTIC SURGERY CTR OF NASHVILLE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician

General Provider Information

NPI Number	:	1205838018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLASTIC SURGERY CTR OF NASHVILLE, PLLC

Provider Business Mailing Address
First Line	:	1915 STATE ST
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-2209
Country	:	US
Telephone Number	:	615-467-6777
Fax Number	:	615-467-6778

Provider Business Practice Location Address
First Line	:	1915 STATE ST
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-2209
Country	:	US
Telephone Number	:	615-467-6777
Fax Number	:	615-467-6778

Authorized Official
Title or Position	:	OWNER, MEDICAL DOCTOR
Name	:	MARY K. GINGRASS
Credential	:	M.D.
Telephone Number	:	615-467-6777

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	05/12/2008

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