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NPI Code Detail

MEDICARE: DR. BRIAN STEPHEN VANDERHOOF D.O.

MEDICARE:  DR. BRIAN STEPHEN VANDERHOOF  D.O.
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
1204C00000XSports Medicine (Neuromusculoskeletal Medicine) Physician038391GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740321579
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRIAN STEPHEN VANDERHOOF D.O.
Provider Business Mailing Address
First Line : 2400 WISTERIA DR
Second Line : SUITE A
City : SNELLVILLE
State : GA
Zip : 30078-2689
Country : US
Telephone Number : 770-985-9330
Fax Number : 770-978-9455
Provider Business Practice Location Address
First Line : 2400 WISTERIA DR
Second Line : SUITE A
City : SNELLVILLE
State : GA
Zip : 30078-2689
Country : US
Telephone Number : 770-985-9330
Fax Number : 770-978-9455
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2007
Last Update Date : 07/08/2007

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Directions to “ DR. BRIAN STEPHEN VANDERHOOF D.O.” Practice Location

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