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General NPI Number Information
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NPI Number | 1386559888
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Entity Type | Organization
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Legal Business Name | TRUFFLES VEIN OF GWINNETT LLC
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Dates
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Enumeration Date | 08/18/2026
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Last Update Date | 08/18/2026
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Provider Practice Location Address
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Address Line | 1780 PRESIDENTIAL CIR # 200
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City | SNELLVILLE
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State | GA
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Zip | 30078-5643
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Country | US
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Telephone | 678-833-1444
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Fax | 678-833-1445
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Provider Business Mailing Address
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Address Line | 1780 PRESIDENTIAL CIR # 200
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City | SNELLVILLE
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State | GA
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Zip | 30078-5643
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Country | US
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Telephone | 678-833-1444
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Fax | 678-833-1445
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS/HR
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Name | CASEY RAY
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Credential | RAY
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Telephone | 678-833-1444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number |
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License Number State |
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