MEDICARE: AURELIA VANDERBURG

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	1223E0200X	Endodontics	DN014507	GA

General Provider Information

NPI Number	:	1831328327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AURELIA VANDERBURG

Provider Business Mailing Address
First Line	:	205 TOM HILL SR BLVD
Second Line	:	SUITE B
City	:	MACON
State	:	GA
Zip	:	31210-1817
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 TOM HILL SR BLVD
Second Line	:	SUITE B
City	:	MACON
State	:	GA
Zip	:	31210-1817
Country	:	US
Telephone Number	:	478-654-3111
Fax Number	:

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

Provider Enumeration Date	:	07/07/2009
Last Update Date	:	01/18/2017

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Directions to “ AURELIA VANDERBURG ” Practice Location

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