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NPI Code Detail

MEDICARE: VANESSA M. VONDUERRING PA-C

MEDICARE: VANESSA M. VONDUERRING PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA.0005378CO
2363AM0700XMedical Physician Assistant5516AZ
3363A00000XPhysician Assistant11174GA

General Provider Information

NPI Number : 1023445657
Entity Type Code : Individual
Provider Name (Legal Business Name) : VANESSA M. VONDUERRING PA-C
Provider Business Mailing Address
First Line : 2900 CHAMBLEE TUCKER RD BLDG 16
Second Line :
City : ATLANTA
State : GA
Zip : 30341-4148
Country : US
Telephone Number : 770-939-1288
Fax Number : 770-212-2203
Provider Business Practice Location Address
First Line : 2900 CHAMBLEE TUCKER RD BLDG 16
Second Line :
City : ATLANTA
State : GA
Zip : 30341-4148
Country : US
Telephone Number : 770-939-1288
Fax Number : 770-212-2203
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2013
Last Update Date : 09/19/2022

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Directions to “ VANESSA M. VONDUERRING PA-C” Practice Location

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