Individual
MICHAEL L VICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
504 W MEMORIAL DR, DALLAS, GA 30132-4119
(770) 505-7190
(770) 793-7413
Mailing address
504 W MEMORIAL DR, DALLAS, GA 30132-4119
(770) 505-7190
(770) 793-7413
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
044656
GA
Other
Enumeration date
10/28/2005
Last updated
07/08/2007
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