Individual
MRS. TANIA C VANDERBILT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
525 VERDAE BLVD STE 200, GREENVILLE, SC 29607-4021
(864) 272-0388
(864) 213-9273
Mailing address
39 DEER TRACK RD, SIMPSONVILLE, SC 29681-4764
(803) 467-1446
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2193
SC
Other
Enumeration date
02/18/2015
Last updated
03/10/2020
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