Healthcare Provider Details

I. General information

NPI: 1467603399
Provider Name (Legal Business Name): VCP NASHVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 10/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 FRANKLIN RD
BRENTWOOD TN
37027-5224
US

IV. Provider business mailing address

447 N BELAIR RD SUITE 103
EVANS GA
30809-3090
US

V. Phone/Fax

Practice location:
  • Phone: 615-329-0029
  • Fax: 615-327-8524
Mailing address:
  • Phone: 706-854-3333
  • Fax: 706-854-2059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number21108
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number26844
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number43956
License Number StateTN

VIII. Authorized Official

Name: DR. KEITH L DAVIS
Title or Position: PARTNER
Credential: M.D.
Phone: 706-854-3333