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AESTHETIC CENTER FOR BREAST AND COSMETIC SURGERY PA NPI 1174906648


NPI Information

NPI: 1174906648
Provider Name: AESTHETIC CENTER FOR BREAST AND COSMETIC SURGERY, PA
Classification: Plastic Surgery - 208200000X
Entity Type: Organization

CLIA Number: 42D1025349

Address:
615 HALTON RD
GREENVILLE, SC
ZIP 29607
Phone: (864) 676-1707
Get Directions

AESTHETIC CENTER FOR BREAST AND COSMETIC SURGERY, PA is a plastic surgery in Greenville, SC. The provider is a plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well. AESTHETIC CENTER FOR BREAST AND COSMETIC SURGERY, PA NPI is 1174906648. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

615 HALTON RD
GREENVILLE, SC
ZIP 29607-403
Phone: (864) 676-1707
Fax: (864) 676-9256

The provider's authorized official is Sutton Lewis Graham .
The authorized official title is Owner and has the following contact phone number (864) 676-1707.

The CLIA number assigned to this NPI record is 42D1025349 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/2/2015 and was last updated on 7/2/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208200000XPlastic Surgery11893SOUTH CAROLINAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1GP0192MEDICAIDSOUTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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