MEDICARE: VCP 2 ATLANTA PC

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	2086S0129X	Vascular Surgery Physician

General Provider Information

NPI Number	:	1528497484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VCP 2 ATLANTA PC

Provider Business Mailing Address
First Line	:	4350 TOWNE CENTRE DR
Second Line	:	SUITE 2000B
City	:	EVANS
State	:	GA
Zip	:	30809-3301
Country	:	US
Telephone Number	:	706-854-3333
Fax Number	:	706-854-2149

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	:	404-846-2440
Fax Number	:	706-854-2149

Authorized Official
Title or Position	:	CEO
Name	:	MRS. KELLY VANN
Credential	:
Telephone Number	:	706-854-2138

Provider Enumeration Date	:	11/01/2013
Last Update Date	:	11/01/2013

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