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General NPI Number Information
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NPI Number | 1275016941
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Entity Type | Organization
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Legal Business Name | VASCULAR AND VEIN INSTITUTE OF THE SOUTH, PLLC
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Dates
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Enumeration Date | 09/10/2018
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 1385 W BRIERBROOK RD
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City | GERMANTOWN
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State | TN
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Zip | 38138-2208
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Country | US
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Telephone | 561-312-1082
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Fax | 800-783-5123
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Provider Business Mailing Address
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Address Line | 1375 W BRIERBROOK RD
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City | GERMANTOWN
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State | TN
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Zip | 38138-2208
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Country | US
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Telephone | 901-390-2930
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Fax | 901-390-2940
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Authorized Official
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Title or Position | OWNER
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Name | ANTON DIAS PERERA
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Credential | MD
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Telephone | 901-390-2930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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