Provider Demographics
NPI:1760733448
Name:TRUFFLES VEIN CENTER, LLC
Entity Type:Organization
Organization Name:TRUFFLES VEIN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-833-1444
Mailing Address - Street 1:874 LANIER AVE W STE 220
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7659
Mailing Address - Country:US
Mailing Address - Phone:678-833-1444
Mailing Address - Fax:678-833-1445
Practice Address - Street 1:874 LANIER AVE W
Practice Address - Street 2:SUITE 120
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7662
Practice Address - Country:US
Practice Address - Phone:678-833-1444
Practice Address - Fax:678-833-1409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA24BCBRWOtherMEDICARE
GA000580423AMedicaid