Provider Demographics
NPI:1720255532
Name:VCP NASHVILLE, LLC
Entity type:Organization
Organization Name:VCP NASHVILLE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
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:30809-3301
Mailing Address - Country:US
Mailing Address - Phone:706-854-3333
Mailing Address - Fax:
Practice Address - Street 1:2222 STATE ST
Practice Address - Street 2:STE 200B-1
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1845
Practice Address - Country:US
Practice Address - Phone:615-329-0029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26844208200000X
TN21108208200000X
TN439562086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370314OtherMEDICARE GROUP PTAN