Individual
DR. STEPHEN D TEDDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6001 PROFESSIONAL PKWY, SUITE 2040, DOUGLASVILLE, GA 30134-5632
(678) 838-9999
(678) 838-9474
Mailing address
6001 PROFESSIONAL PKWY, SUITE 2040, DOUGLASVILLE, GA 30134-5632
(678) 838-9999
(678) 838-9474
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
049112
GA
207W00000X
Ophthalmology Physician
ME71025
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000719155J
—
GA
01
—
08-01712
EVERCARE
GA
01
—
324017
WELLCARE
GA
01
—
4299075
CIGNA
GA
01
—
930413
BCBS
GA
01
—
P00239339
RAILROAD MEDICARE
GA
Enumeration date
06/22/2005
Last updated
06/13/2017
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