MEDICARE: VCP ATLANTA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	033061	GA
2	2086S0129X	Vascular Surgery Physician	48566	GA

General Provider Information

NPI Number	:	1437484185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VCP ATLANTA, LLC

Provider Business Mailing Address
First Line	:	4350 TOWNE CENTRE DR
Second Line	:	STE 2000
City	:	EVANS
State	:	GA
Zip	:	30809-3301
Country	:	US
Telephone Number	:	706-854-3333
Fax Number	:	706-396-0615

Provider Business Practice Location Address
First Line	:	3390 PEACHTREE RD NE
Second Line	:	STE 425
City	:	ATLANTA
State	:	GA
Zip	:	30326-1157
Country	:	US
Telephone Number	:	404-846-2460
Fax Number	:	404-846-2440

Authorized Official
Title or Position	:	SOLE MEMBER/PRESIDENT
Name	:	STEVEN M ROTH
Credential	:	MD
Telephone Number	:	706-854-2138

Provider Enumeration Date	:	10/14/2009
Last Update Date	:	05/23/2012

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Directions to “VCP ATLANTA, LLC ” Practice Location

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