Provider Demographics
NPI:1487629655
Name:KLEIN, VONDA L (MD)
Entity Type:Individual
Prefix:
First Name:VONDA
Middle Name:L
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VONDA
Other - Middle Name:L
Other - Last Name:BROKOPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:699 CHURCH ST NE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1116
Mailing Address - Country:US
Mailing Address - Phone:770-422-8505
Mailing Address - Fax:770-424-7449
Practice Address - Street 1:699 CHURCH ST NE
Practice Address - Street 2:SUITE 220
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1116
Practice Address - Country:US
Practice Address - Phone:770-422-8505
Practice Address - Fax:770-424-7449
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035826207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00659579DMedicaid
GA0700105OtherUNITED HEALTHCARE
GA1331254-004OtherCIGNA
GA4486146OtherAETNA
GA671722OtherBCBS
GA00659579EMedicaid
GA00659579CMedicaid
GA323444OtherWELLCARE
GA10054024OtherAMERIGROUP
GA00659579CMedicaid
GA00659579EMedicaid