Individual
DR. RAYMOND DANIEL VICKERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
6600 VAN AALST BLVD BLDG 9250, FORT BENNING, GA 31905-2102
(762) 408-2532
Mailing address
6600 VAN AALST BLVD BLDG 9250, FORT BENNING, GA 31905-2102
(762) 408-2532
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
—
—
207Q00000X
Family Medicine Physician
Primary
98041
GA
208D00000X
General Practice Physician
98041
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
98041
MEDICAL LICENSE
GA
Enumeration date
06/08/2022
Last updated
06/10/2025
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