Individual
STEPHANIE L VANDERVELDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1100 JOHNSON FERRY RD NE, SUITE 593, ATLANTA, GA 30342-1709
(404) 255-9096
(404) 255-9097
Mailing address
1100 JOHNSON FERRY RD NE, SUITE 593, ATLANTA, GA 30342-1709
(404) 255-9096
(404) 255-9097
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
61013
GA
207W00000X
Ophthalmology Physician
ME95854
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
61013
GEORGIA COMPOSITE MEDICAL BOARD
GA
Enumeration date
06/08/2006
Last updated
04/05/2023
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