Provider Demographics
NPI:1194284299
Name:POOLER PLASTIC SURGERY LLC
Entity type:Organization
Organization Name:POOLER PLASTIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:PETTIGREW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-988-1781
Mailing Address - Street 1:1000 TOWNE CENTER BLVD STE 501
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4061
Mailing Address - Country:US
Mailing Address - Phone:912-988-1781
Mailing Address - Fax:912-777-7591
Practice Address - Street 1:1000 TOWNE CENTER BLVD STE 506
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4068
Practice Address - Country:US
Practice Address - Phone:912-988-1781
Practice Address - Fax:912-777-7591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty