NPIMap

Organization Active NPI

Truffles Vein Center, LLC

  • Plastic Surgery Physician
  • Fayetteville, GA
National Provider Identifier
1760733448
Registry record updated Jul 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
Legal business name
TRUFFLES VEIN CENTER, LLC
Practice address
874 Lanier Ave W
Suite 120
Fayetteville, GA 30214-7662
Phone
(678) 833-1444
Fax
(678) 833-1409
NPI assigned
Sep 21, 2012
Last updated
Jul 23, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Paul David Feldman, M.D.NPI 1588656367
Title
Owner
Phone
(678) 833-1444

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208200000X Primary

Addresses

Primary practice location

874 Lanier Ave W
Suite 120
Fayetteville, GA 30214-7662

Mailing address

874 Lanier Ave W Ste 220
Fayetteville, GA 30214-7659
Phone (678) 833-1444

Other practice location 1

86 Vinings Dr
McDonough, GA 30253-5994
Phone (678) 833-1444

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130114000391 GA Part B Supplier - Clinic/Group Practice 1355594797 Receives reassigned benefits from 24 practitioners
Practice locations: Fayetteville, GA; Powder Springs, GA; Newnan, GA; McDonough, GA; Carrolton, GA

National Provider Directory

National Provider Directory

Locations

874 Lanier Ave W
Ste 120
Fayetteville, GA 30214
Phone (678) 833-1444

5041 Dallas Hwy
Powder Springs, GA 30127
Phone (678) 305-9200

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1348185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595462400000",
    "number": "1760733448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "874 LANIER AVE W STE 220",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147659",
            "telephone_number": "678-833-1444",
            "fax_number": "678-833-1445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "874 LANIER AVE W",
            "address_2": "SUITE 120",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147662",
            "telephone_number": "678-833-1444",
            "fax_number": "678-833-1409"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "86 Vinings Dr",
            "address_purpose": "LOCATION",
            "city": "McDonough",
            "state": "GA",
            "postal_code": "302535994",
            "country_code": "US",
            "telephone_number": "678-833-1444",
            "fax_number": "678-833-1445",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TRUFFLES VEIN CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-21",
        "last_updated": "2020-07-23",
        "certification_date": "2020-07-23",
        "status": "A",
        "authorized_official_last_name": "FELDMAN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-833-1444",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2020; 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.

Verify at the official NPI Registry.