Provider Demographics
NPI:1457165201
Name:VCP 2 GREENSBORO PC
Entity type:Organization
Organization Name:VCP 2 GREENSBORO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL PRACTICAL ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEWELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLIBURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-888-1256
Mailing Address - Street 1:1109 MEDICAL CENTER DR BLDG 1A
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6633
Mailing Address - Country:US
Mailing Address - Phone:706-888-1256
Mailing Address - Fax:706-854-2149
Practice Address - Street 1:1061 PARK DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-3465
Practice Address - Country:US
Practice Address - Phone:866-328-8346
Practice Address - Fax:706-854-2149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty