Active NPI
Truffles Vein Center, LLC
- Plastic Surgery Physician
- Fayetteville, GA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- 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
- 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
- Dr. Paul David Feldman, M.D.
- 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) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 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
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 24BCBRW | Other | GA | MEDICARE |
| 000580423A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
874 Lanier Ave W
Ste 120
Fayetteville, GA 30214
Phone (678) 833-1444
874 Lanier Ave W
Ste 220
Fayetteville, GA 30214
Phone (678) 833-1444
96 Vinings Dr
McDonough, GA 30253
Phone (678) 833-1444
8 E Court Sq
Newnan, GA 30263
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.
-
- Plastic Surgery Physician
- Fayetteville, GA
- NPI 1588656367
GA, Plastic Surgery
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": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "24BCBRW",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000580423A",
"state": "GA"
}
],
"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.