Provider Demographics
NPI:1194079962
Name:VCP MEMPHIS, LLC
Entity type:Organization
Organization Name:VCP MEMPHIS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:B
Authorized Official - Last Name:VANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-854-2138
Mailing Address - Street 1:8000 WOLF RIVER BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1754
Mailing Address - Country:US
Mailing Address - Phone:706-854-3333
Mailing Address - Fax:706-396-0615
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:30809-3301
Practice Address - Country:US
Practice Address - Phone:706-854-2138
Practice Address - Fax:706-396-0615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty