Kenwana Michelle Vanderbilt, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY003494 Issued in GA

Practice address

Macon Outpatient Clinic- 5398 Thomaston Rd.
Suite B
Macon, GA 31220

Phone

(478) 476-8868

Fax

(478) 476-8161

NPI assigned

Mar 5, 2013

Last updated

Mar 9, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Kenwana Michelle Lewis Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1362441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457481600000",
    "number": "1174864979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MACON OUTPATIENT CLINIC- 5398 THOMASTON RD.",
            "address_2": "SUITE B",
            "city": "MACON",
            "state": "GA",
            "postal_code": "31220",
            "telephone_number": "478-476-8868",
            "fax_number": "478-476-8161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MACON OUTPATIENT CLINIC- 5398 THOMASTON RD.",
            "address_2": "SUITE B",
            "city": "MACON",
            "state": "GA",
            "postal_code": "31220",
            "telephone_number": "478-476-8868",
            "fax_number": "478-476-8161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERBILT",
        "first_name": "KENWANA",
        "middle_name": "MICHELLE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-05",
        "last_updated": "2016-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY003494",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENWANA",
            "last_name": "LEWIS",
            "middle_name": "MICHELLE",
            "prefix": "DR.",
            "credential": "PSY.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sandra Valle, FNP
• Stephanie Van Dine
• Gennifer Leigh Van Pelt, LPC
• Luther Vance Jr., MD
• Christina Michelle Vandalinda, NP
• Aurelia Vanderburg
• Joseph Vandewater
• Kasandra Grizzard Vanegas, DPT
• Rahul Kumar Vangala, M.D.
• Vanguard Anesthesia Partners

• Clinical Psychologist in Macon, GA
• Providers in Macon, GA by specialty
• Clinical Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.