Healthcare Provider Details

I. General information

NPI: 1346357217
Provider Name (Legal Business Name): VASCULAR RADIOLOGY ASSOCIATES, II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 13TH STREET SUITE 250
AUGUSTA GA
30901
US

IV. Provider business mailing address

1125 TROUPE ST
AUGUSTA GA
30904-4480
US

V. Phone/Fax

Practice location:
  • Phone: 706-724-2500
  • Fax: 706-731-5289
Mailing address:
  • Phone: 706-667-7450
  • Fax: 706-731-5289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number018827
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number018827
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number018827
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number018827
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number018827
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number018827
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number018827
License Number StateGA
# 8
Primary TaxonomyN
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number018827
License Number StateGA
# 9
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number018827
License Number StateGA

VIII. Authorized Official

Name: DR. WILLIAM BRUCE TANNEHILL
Title or Position: PARTNER
Credential: M.D.
Phone: 706-667-7450