MEDICARE: DR. STEPHEN D TEDDER M.D.

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
1	207W00000X	Ophthalmology Physician	ME71025	FL
2	207W00000X	Ophthalmology Physician	049112	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00239339	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08-01712	OTHER	GA	EVERCARE
2	324017	OTHER	GA	WELLCARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	4299075	OTHER	GA	CIGNA
6	930413	OTHER	GA	BCBS

General Provider Information

NPI Number	:	1093711186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN D TEDDER M.D.

Provider Business Mailing Address
First Line	:	6001 PROFESSIONAL PKWY
Second Line	:	SUITE 2040
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30134-5632
Country	:	US
Telephone Number	:	678-838-9999
Fax Number	:	678-838-9474

Provider Business Practice Location Address
First Line	:	6001 PROFESSIONAL PKWY
Second Line	:	SUITE 2040
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30134-5632
Country	:	US
Telephone Number	:	678-838-9999
Fax Number	:	678-838-9474

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	06/13/2017

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