Aesthetic Center for Breast and Cosmetic Surgery, PA
Organization Active NPI Plastic Surgery Physician · Greenville, SC
NPI 1174906648 · NPPES record last updated Jul 2, 2015
Key facts
- NPI
- 1174906648
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Plastic Surgery Physician 208200000X
- License
- 11893 (SC)
- Legal business name
- AESTHETIC CENTER FOR BREAST AND COSMETIC SURGERY, PA
- Practice address
- 615 Halton Rd
Greenville, SC 29607-3403 - Phone
- (864) 676-1707
- Fax
- (864) 676-9256
- NPI assigned
- Jul 2, 2015
- Organization subpart
- No
Authorized official
- Name
- Mr. Sutton Lewis Graham II, MD
- Title
- Owner
- Phone
- (864) 676-1707
Practitioners 2
-
Allison J Bishop, MSN, FNP-BC, APRN
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 42D1025349 | Aesthetic Center for Breast and Cosmetic Surgery | Certificate of waiver | May 4, 2028 |
National Provider Directory
Locations
615 Halton Rd
Greenville, SC 29607
Phone (864) 676-1707
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician |
208200000X | 11893 | SC | Yes |
Addresses
Primary practice location
615 Halton Rd
Greenville, SC 29607-3403
Mailing address
615 Halton Rd
Greenville, SC 29607-3403
Phone (864) 676-1707
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GP0192 | Medicaid | SC |
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 2, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.