Organization
VCP 2 LOUISIANA PROFESSIONAL CORPORATION
Active
Other names
Vein Guys
Organization subpart
No
Provider details
NPI number
Authorized official
JEWELL HALLIBURTON (REGIONAL PRACTICE ADMINISTRATOR)
(706) 888-1256
Entity
Organization
Contact information
Practice address
750 BAYOU PINES EAST DR, LAKE CHARLES, LA 70601-7184
(866) 328-8346
(706) 854-2149
Mailing address
1109 MEDICAL CENTER DR BLDG 1A, AUGUSTA, GA 30909-6633
(866) 328-8346
(706) 854-2149
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
11/05/2024
Last updated
02/04/2025
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