Provider Demographics
NPI:1861760027
Name:VEIN SPECIALISTS OF THE SOUTH
Entity type:Organization
Organization Name:VEIN SPECIALISTS OF THE SOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-743-2472
Mailing Address - Street 1:556 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-7934
Mailing Address - Country:US
Mailing Address - Phone:478-743-2472
Mailing Address - Fax:478-743-1516
Practice Address - Street 1:556 3RD ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7934
Practice Address - Country:US
Practice Address - Phone:478-743-2472
Practice Address - Fax:478-743-1516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA02BDBWGMedicare PIN