Victoria Harris Thedford, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

054039 Issued in GA

Practice address

483 Upper Riverdale Rd SW Ste B
Riverdale, GA 30274-2579

Phone

(770) 968-1997

Fax

(770) 968-1918

NPI assigned

Jan 25, 2007

Last updated

Mar 6, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Familycare Medical, LLC

  • Family Medicine Physician
  • Morrow, GA
  • NPI 1215171459
  Authorized official Same address or phone
• Georgia Retina, PC

  • Ophthalmology Physician
  • Atlanta, GA
  • NPI 1023027430
  NPD (past)
• Jorge a. Bueno Chiropractic LLC

  • Nutrition Chiropractor
  • Acworth, GA
  • NPI 1962679340
  NPD (past)

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741219200000",
    "number": "1730235771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 783",
            "city": "REX",
            "state": "GA",
            "postal_code": "302730783",
            "telephone_number": "770-968-1997",
            "fax_number": "770-968-1918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "483 UPPER RIVERDALE RD SW STE B",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742579",
            "telephone_number": "770-968-1997",
            "fax_number": "770-968-1918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEDFORD",
        "first_name": "VICTORIA",
        "middle_name": "HARRIS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-25",
        "last_updated": "2025-03-06",
        "certification_date": "2025-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "054039",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "054039",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "054039",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "187347049E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tender Heart Homecare Services LLC
• Idrisse B Tetsadjio, PHARMACIST
• The Kiya House, Inc.
• The Kroger Co (Kroger Pharmacy)
• The Margie Ree Hansford Thurmond Family Life Center
• Thera-Core
• There's No Place Like Home Private Duty LLC
• Gabrielle Thomas
• Jacquelyn Thompson
• Josephine Thompson

• Family Medicine Physician in Riverdale, GA
• Providers in Riverdale, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2025; 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.