Individual
LISA VICKERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
321 WOODLAND RD, MONROE, GA 30655-2021
(770) 267-3918
Mailing address
PO BOX 551, MONROE, GA 30655-0551
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25683
GA
Other
Enumeration date
06/28/2017
Last updated
06/28/2017
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