Individual
MITCHAEL LEE VICKERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2500 HOSPITAL BLVD, SUITE 480, ROSWELL, GA 30076-4975
(678) 762-0676
Mailing address
1870 MAYFIELD RD, ALPHARETTA, GA 30009-1552
(678) 763-5144
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN141647
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000806242M
—
GA
01
—
P00232387
RR MEDICARE
—
Enumeration date
03/16/2006
Last updated
11/18/2010
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