Healthcare Provider Details

I. General information

NPI: 1497624332
Provider Name (Legal Business Name): VRA PHYSICIANS III LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 10/30/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 WHEELER ROAD
AUGUSTA GA
30909-6521
US

IV. Provider business mailing address

1125 TROUPE STREET
AUGUSTA GA
30904-4480
US

V. Phone/Fax

Practice location:
  • Phone: 706-651-6105
  • Fax: 706-651-6774
Mailing address:
  • Phone: 706-667-7450
  • Fax: 706-731-5289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM BRUCE TANNEHILL
Title or Position: DEN
Credential:
Phone: 706-651-6105