Active NPI
VCP2 Augusta PC
- Vascular Surgery Physician
- Evans, GA
National Provider Identifier
1124456306
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular Surgery Physician
- Legal business name
- VCP2 AUGUSTA PC
- Practice address
- 4350 Towne Centre Dr
Ste 2000
Evans, GA 30809-3331 - Phone
- (706) 854-3333
- Fax
- (706) 854-2149
- NPI assigned
- Oct 24, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jewell Halliburton
- Title
- Regional Practice Manager
- Phone
- (706) 854-3333
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular Surgery Physician | 2086S0129X | Primary |
Addresses
Primary practice location
4350 Towne Centre Dr
Ste 2000
Evans, GA 30809-3331
Mailing address
4350 Towne Centre Dr
Ste 2000
Evans, GA 30809-3331
Phone (706) 854-3333
Other names 1
- Vein Guys Augusta PC
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140307001018 | GA | Part B Supplier - Clinic/Group Practice | 4981834124 |
Receives reassigned benefits from 8 practitioners Practice locations: Augusta, GA; Greensboro, GA |
National Provider Directory
National Provider DirectoryLocations
4350 Towne Centre Dr
Ste 2000B
Evans, GA 30809
Phone (706) 396-0613
1061 Park Dr
Ste 2000
Greensboro, GA 30642
353 New Shackle Island Rd
Ste 102A
Hendersonvlle, TN 37075
Phone (615) 384-8211
Practitioners & affiliated clinicians
Practitioners 8
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1382572800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1687132800000",
"number": "1124456306",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4350 TOWNE CENTRE DR",
"address_2": "STE 2000",
"city": "EVANS",
"state": "GA",
"postal_code": "308093331",
"telephone_number": "706-854-3333",
"fax_number": "706-854-2149"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4350 TOWNE CENTRE DR",
"address_2": "STE 2000",
"city": "EVANS",
"state": "GA",
"postal_code": "308093331",
"telephone_number": "706-854-3333",
"fax_number": "706-854-2149"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VCP2 AUGUSTA PC",
"organizational_subpart": "NO",
"enumeration_date": "2013-10-24",
"last_updated": "2023-06-19",
"certification_date": "2023-06-19",
"status": "A",
"authorized_official_last_name": "HALLIBURTON",
"authorized_official_first_name": "JEWELL",
"authorized_official_title_or_position": "REGIONAL PRACTICE MANAGER",
"authorized_official_telephone_number": "706-854-3333"
},
"taxonomies": [
{
"code": "2086S0129X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Surgery, Vascular Surgery",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Vein Guys Augusta PC",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Evans, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.