Provider Demographics
NPI:1144286865
Name:WARE, VONDA ROEBUCK (MD)
Entity type:Individual
Prefix:
First Name:VONDA
Middle Name:ROEBUCK
Last Name:WARE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 WESTVIEW DR SW
Mailing Address - Street 2:HARRIS BUILDING
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-3031
Mailing Address - Country:US
Mailing Address - Phone:404-752-1000
Mailing Address - Fax:404-752-1922
Practice Address - Street 1:1800 HOWELL MILL RD NW STE 275
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-3098
Practice Address - Country:US
Practice Address - Phone:404-752-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME148590207V00000X
GA44372207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4232900794MMedicaid
TN1514656Medicaid
TN3042193Medicare PIN
GA16BBCZQMedicare PIN