Provider Demographics
NPI:1427743715
Name:VASCULAR AND VEIN INSTITUTE OF THE SOUTH, PLLC
Entity type:Organization
Organization Name:VASCULAR AND VEIN INSTITUTE OF THE SOUTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ANTON
Authorized Official - Middle Name:D
Authorized Official - Last Name:PERERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-390-2930
Mailing Address - Street 1:1385 W BRIERBROOK RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2208
Mailing Address - Country:US
Mailing Address - Phone:901-390-2930
Mailing Address - Fax:
Practice Address - Street 1:1355 W BRIERBROOK RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2208
Practice Address - Country:US
Practice Address - Phone:901-390-2930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-11
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty