Stephen D Tedder, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

049112 Issued in GA

Practice address

6001 Professional Pkwy
Suite 2040
Douglasville, GA 30134-5632

Phone

(678) 838-9999

Fax

(678) 838-9474

NPI assigned

Jun 22, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Marietta Eye Clinic PA

  dba Marietta Eye Surgery at Johns Creek

  • Ophthalmologic Surgery Clinic/Center
  • Suwanee, GA
  • NPI 1225836869
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1497312000000",
    "number": "1093711186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6001 PROFESSIONAL PKWY",
            "address_2": "SUITE 2040",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301345632",
            "telephone_number": "678-838-9999",
            "fax_number": "678-838-9474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6001 PROFESSIONAL PKWY",
            "address_2": "SUITE 2040",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301345632",
            "telephone_number": "678-838-9999",
            "fax_number": "678-838-9474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEDDER",
        "first_name": "STEPHEN",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2017-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "FL",
            "license": "ME71025",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "GA",
            "license": "049112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE",
            "identifier": "08-01712",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "324017",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00239339",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000719155J",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "4299075",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "930413",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel Cohen Taylor, MD
• TC Medicals LLC
• Eleth P. Teape, R.N.
• Tedder Medical LLC
• Hampton Tedder
• Camilla Terrell
• Mark Anthony Terry, PHARM. D.
• Prashanth Thalanayar Muthukrishnan, MD
• The Atlatna Cardiology Group, PC (ACG Douglasville)
• The Chiro Place Collective - Douglasville PC

• Ophthalmology Physician in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Ophthalmology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.