Individual
MR. JOHNATHAN VICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LDO
Contact information
Practice address
7325 JONESBORO RD, MORROW, GA 30260-2950
(404) 583-5162
(678) 422-0759
Mailing address
7325 JONESBORO RD, MORROW, GA 30260-2950
(404) 583-5162
(678) 422-0759
Taxonomy
Speciality
Code
Description
License number
State
156FC0800X
Contact Lens Technician/Technologist
002489
—
156FX1800X
Optician
Primary
002489
GA
171400000X
Health & Wellness Coach
—
—
Other
Enumeration date
11/20/2023
Last updated
11/20/2023
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