Basic Information
| Provider Information | |||||||||
| NPI: | 1942484613 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TIERNEY PLASTIC SURGERY PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2004 HAYES STREET | ||||||||
| Address2: | SUITE 315 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372032647 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2004 HAYES STREET | ||||||||
| Address2: | STE 315 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372032647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153208585 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2007 | ||||||||
| LastUpdateDate: | 02/03/2017 | ||||||||
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| AuthorizedOfficialLastName: | TIERNEY | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 6153208585 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | MD37454 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | DE3329 | 01 | TN | PALMETTO GBA RAILROAD MED | OTHER |