MEDICARE: VERNU 2 INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0204X	Vascular & Interventional Radiology Physician

General Provider Information

NPI Number	:	1770362873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERNU 2 INC

Provider Business Mailing Address
First Line	:	3333 OLD MILTON PKWY STE 360
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-4626
Country	:	US
Telephone Number	:	770-755-5441
Fax Number	:

Provider Business Practice Location Address
First Line	:	3333 OLD MILTON PKWY STE G100-A
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-4626
Country	:	US
Telephone Number	:	770-755-5441
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	JACQUELINE SANDERS
Credential	:
Telephone Number	:	502-630-2036

Provider Enumeration Date	:	09/27/2023
Last Update Date	:	09/27/2023

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