NPIMap

Organization Active NPI

Dalton Plastic Surgery Center

  • Plastic Surgery Physician
  • Dalton, GA
National Provider Identifier
1659606408
Registry record updated Mar 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
023677 Issued in GA
Legal business name
DALTON PLASTIC SURGERY CENTER
Practice address
1501 Broadrick Drive
Suite 1
Dalton, GA 30720
Phone
(706) 226-3311
Fax
(706) 275-8723
NPI assigned
Oct 13, 2009
Last updated
Mar 1, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Reginald Sherrill, MDNPI 1528007663
Title
Owner
Phone
(706) 226-3311

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X 023677 GA Primary

Addresses

Primary practice location

1501 Broadrick Drive
Suite 1
Dalton, GA 30720

Mailing address

1501 Broadrick Drive
Suite 1
Dalton, GA 30720
Phone (706) 226-3311

Other identifiers 1

IdentifierTypeStateIssuer
00245627AMedicaidGA

National Provider Directory

National Provider Directory

Locations

1501 Broadrick Dr
Ste 1
Dalton, GA 30720
Phone (706) 226-3311

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1255392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267401600000",
    "number": "1659606408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 BROADRICK DRIVE",
            "address_2": "SUITE 1",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "30720",
            "telephone_number": "706-226-3311",
            "fax_number": "706-275-8723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 BROADRICK DRIVE",
            "address_2": "SUITE 1",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "30720",
            "telephone_number": "706-226-3311",
            "fax_number": "706-275-8723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DALTON PLASTIC SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-13",
        "last_updated": "2010-03-01",
        "status": "A",
        "authorized_official_last_name": "SHERRILL",
        "authorized_official_first_name": "REGINALD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-226-3311",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "GA",
            "license": "023677",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00245627A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dalton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.