Provider Demographics
NPI:1124456306
Name:VCP2 AUGUSTA PC
Entity type:Organization
Organization Name:VCP2 AUGUSTA PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEWELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLIBURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-854-3333
Mailing Address - Street 1:4350 TOWNE CENTRE DR
Mailing Address - Street 2:STE 2000
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3331
Mailing Address - Country:US
Mailing Address - Phone:706-854-3333
Mailing Address - Fax:706-854-2149
Practice Address - Street 1:4350 TOWNE CENTRE DR
Practice Address - Street 2:STE 2000
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3331
Practice Address - Country:US
Practice Address - Phone:706-854-3333
Practice Address - Fax:706-854-2149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty