Individual
DR. JOHN DAVID VICKERY IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
37 CALUMET PKWY, BUILDING F, SUITE 201, NEWNAN, GA 30263-6734
(770) 683-4050
Mailing address
690 DALLAS HWY, SUITE 101, VILLA RICA, GA 30180-1264
(770) 459-0620
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
44948
TN
207K00000X
Allergy & Immunology Physician
Primary
67624
GA
207R00000X
Internal Medicine Physician
44948
TN
207R00000X
Internal Medicine Physician
67624
GA
Other
Enumeration date
04/13/2007
Last updated
05/20/2013
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