Provider Demographics
NPI:1275656472
Name:WADDY, VAN SCHRODER (MED)
Entity Type:Individual
Prefix:MS
First Name:VAN
Middle Name:SCHRODER
Last Name:WADDY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MS
Other - First Name:VAN
Other - Middle Name:SCHRODER
Other - Last Name:WADDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED
Mailing Address - Street 1:351 DELMONT DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-3220
Mailing Address - Country:US
Mailing Address - Phone:404-233-4401
Mailing Address - Fax:
Practice Address - Street 1:351 DELMONT DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-3220
Practice Address - Country:US
Practice Address - Phone:404-233-4401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA355106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist