Basic Information
| Provider Information | |||||||||
| NPI: | 1982273488 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STERLING PLASTIC SURGERY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 LIVE OAK CT | ||||||||
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| City: | MOULTRIE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317686783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2297852400 | ||||||||
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| Address1: | 4 LIVE OAK CT | ||||||||
| Address2: | |||||||||
| City: | MOULTRIE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317686783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2297852400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2021 | ||||||||
| LastUpdateDate: | 06/21/2021 | ||||||||
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| AuthorizedOfficialLastName: | MCGOWAN | ||||||||
| AuthorizedOfficialFirstName: | ASHLEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF PRACTICE MANAGEMENT | ||||||||
| AuthorizedOfficialTelephone: | 2298909115 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0122X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery |
No ID Information.