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General NPI Number Information
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NPI Number | 1457165201
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Entity Type | Organization
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Legal Business Name | VCP 2 GREENSBORO PC
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 1061 PARK DR
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City | GREENSBORO
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State | GA
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Zip | 30642-3465
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Country | US
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Telephone | 866-328-8346
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Fax | 706-854-2149
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Provider Business Mailing Address
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Address Line | 1109 MEDICAL CENTER DR BLDG 1A
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City | AUGUSTA
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State | GA
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Zip | 30909-6633
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Country | US
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Telephone | 706-888-1256
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Fax | 706-854-2149
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Authorized Official
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Title or Position | REGIONAL PRACTICAL ADMINISTRATOR
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Name | MRS. JEWELL HALLIBURTON
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Credential |
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Telephone | 706-888-1256
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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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