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General NPI Number Information
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NPI Number | 1497624332
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Entity Type | Organization
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Legal Business Name | VRA PHYSICIANS III LLC
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Dates
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Enumeration Date | 10/30/2025
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 3651 WHEELER ROAD
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City | AUGUSTA
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State | GA
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Zip | 30909-6521
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Country | US
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Telephone | 706-651-6105
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Fax | 706-651-6774
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Provider Business Mailing Address
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Address Line | 1125 TROUPE STREET
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City | AUGUSTA
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State | GA
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Zip | 30904-4480
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Country | US
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Telephone | 706-667-7450
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Fax | 706-731-5289
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Authorized Official
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Title or Position | DEN
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Name | WILLIAM BRUCE TANNEHILL
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Credential |
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Telephone | 706-651-6105
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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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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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