DR. KENWANA MICHELLE VANDERBILT (NPI# 1174864979) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174864979 |
| Entity Type | Individual |
| Full Name | DR. KENWANA MICHELLE VANDERBILT |
| Other Name | DR. KENWANA MICHELLE LEWIS |
| Credential | PSY.D. |
| Practice Address |
Macon Outpatient Clinic- 5398 Thomaston Rd. Suite B Macon GA 31220 |
| Practice Telephone | 4784768868 |
| Practice Fax Number | 4784768161 |
| Mailing Telephone | 4784768868 |
| Mailing Fax Number | 4784768161 |
| Enumeration Date | 2013-03-05 |
| Last Update Date | 2016-03-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
PSY003494 | GA | Behavioral Health & Social Service Providers |
| Street Address |
MACON OUTPATIENT CLINIC- 5398 THOMASTON RD. SUITE B |
| City | MACON |
| State | GA |
| Zip Code | 31220 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720287345 | Lynda Jean Logan | Registered Nurse | 5398 Thomaston Road Suite B, Macon, GA 31220 | 2007-07-13 |
| 1811085434 | Timmi Hagan | Dentist | 4196 Cavalier Dr, Macon, GA 31220 | 2006-10-10 |
| 1154375756 | Lois Jane Macdonnell | Psychiatry & Neurology | 5566 Thomaston Rd, Macon, GA 31220 | 2006-05-19 |
| 1508129438 | Venyette Thomas | Nurse Practitioner | 6381 Zebulon Rd, Macon, GA 31220 | 2012-06-15 |
| 1710260575 | Vijay H Patel | Pharmacist | 1280 Gray Hwy, Macon, GA 31220 | 2011-09-27 |
| 1023065638 | Dublin Vamc | Clinic/Center | 5566 Thomaston Rd, Macon, GA 31220 | 2006-05-28 |
| 1386847614 | Georgia Cvs Pharmacy, L.L.C. | Durable Medical Equipment & Medical Supplies | 6381 Zebulon Rd, Macon, GA 31220-2601 | 2007-06-06 |
| 1588128581 | Samuel Scott Collier | Nurse Practitioner | 6381 Zebulon Rd, Macon, GA 31220-2601 | 2019-01-24 |
| 1841652310 | Christopher Hayes | Nurse Practitioner | 6381 Zebulon Rd, Macon, GA 31220-2601 | 2016-03-24 |
| 1598124380 | Jessica Lynn | Nurse Practitioner | 6381 Zebulon Rd, Macon, GA 31220-2601 | 2016-02-22 |
| Find all providers in zip 31220 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073833638 | Michael R Johns Psyd | Psychologist | 3678 Vineville Ave, Macon, GA 31204-1868 | 2010-06-07 |
| 1710024385 | Melissa Hicks | Psychologist | 6601 Zebulon Rd, Macon, GA 31220-7606 | 2007-01-31 |
| 1174679062 | Stacey Smoot Owen | Psychologist | 5398 Thomaston Rd, Suite B, Macon, GA 31220-8110 | 2007-01-25 |
| 1902969363 | Jal Psychological Services | Psychologist | 3626 Vineville Ave, Macon, GA 31204-1853 | 2006-12-18 |
| 1801983325 | Steven Alan Hobbs | Psychologist | 655 1st St, Macon, GA 31201-2852 | 2006-10-06 |
| 1063420875 | Mark J. Prigatano | Psychologist | 146 Pierce Ave, Macon, GA 31204-2871 | 2006-08-04 |
| 1407488968 | Christina Lynn Charette | Psychologist | 4931 Riverside Dr # 400a, Macon, GA 31210-1156 | 2020-02-12 |
| 1801319447 | Neha Khorana | Psychologist | 250 Martin Luther King Jr Blvd, Macon, GA 31201-3490 | 2017-07-25 |
| 1154602910 | Dinah K Ayna | Psychologist | 250 Martin Luther King Jr Blvd, Macon, GA 31201-3490 | 2011-09-07 |
| 1548588825 | Jeffrey A Wilson-reese | Psychologist | 4600 Fulton Mill Rd, Central S.p. Mental Health Dept., Macon, GA 31208-2500 | 2010-05-11 |
| Find all providers in MACON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.