P Praxis·MD
● Active Type 1 · Individual

DR. Kenwana Michelle Vanderbilt, PSY.D.

Psychologist·MacOn, GA· NPI 1174864979 · Enumerated 2013 · 13 years on NPI
Vanderbilt is 1 of 20 psychologist providers in MacOn and 1 of 1487 in Georgia.
NPI age
13 years
Enumerated 2013-03-05
Primary specialty
Psychologist
Licensed in
GA
1 state
Status
Active
No deactivations on record
Last NPPES update
2016-03-09
Source: monthly bulk 2026-05
Sole proprietor
No
May be part of a larger org

How this provider compares

Across 1487 active psychologist providers in Georgia.

NPI age
13 years
↓ 4 yr below median (17 yr)
State licenses
1 state
6% of peers hold multiple states
Subspecialties
0
18% of peers hold subspecialties

NPI lifetime · 2013 → 2026

2013-03Enumerated in NPPES
2013 2026

Where they practice

Practice location
MacOn Outpatient Clinic- 5398 Thomaston Rd., Suite B
MacOn, GA 31220
📞 4784768868fax 4784768161
Mailing address
MacOn Outpatient Clinic- 5398 Thomaston Rd., Suite B
MacOn, GA 31220
📞 4784768868fax 4784768161

Specialties

  • Psychologist Primary
    A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a...
    GA license #PSY003494 taxonomy 103TC0700X

Practice context

Solo or small practice. No other active providers share this practice address in NPPES.

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How to verify this provider

  1. Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
  2. Check the state license is currently active.State licensing boards publish current status; NPPES does not.
  3. Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.

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