Basic Information
| Provider Information | |||||||||
| NPI: | 1053395111 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FACES PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 24023 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392254023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013661400 | ||||||||
| FaxNumber: | 6013668167 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 HIGHLAND COLONY PARKWAY | ||||||||
| Address2: | SUITE G | ||||||||
| City: | RIDGELAND | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016073033 | ||||||||
| FaxNumber: | 6018534939 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2005 | ||||||||
| LastUpdateDate: | 05/04/2012 | ||||||||
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| AuthorizedOfficialLastName: | CARLIN | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
| AuthorizedOfficialMiddleName: | HARRIS | ||||||||
| AuthorizedOfficialTitleorPosition: | BOOKKEEPER | ||||||||
| AuthorizedOfficialTelephone: | 6016073033 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery |
No ID Information.