Provider Demographics
NPI:1497500375
Name:COLUMBIA PLASTIC SURGERY, LLC
Entity type:Organization
Organization Name:COLUMBIA PLASTIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:BRETT
Authorized Official - Last Name:CARLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-926-0969
Mailing Address - Street 1:3634 SUNSET BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3634 SUNSET BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169
Practice Address - Country:US
Practice Address - Phone:803-926-0969
Practice Address - Fax:803-926-0757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty