Individual
SHERYL B VICKERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
203 OAKSIDE LN STE C, CANTON, GA 30114-6407
(470) 410-7911
(770) 604-1929
Mailing address
PO BOX 5554, CANTON, GA 30114-0290
(470) 410-7911
(770) 604-1929
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
026446
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08BBSBL
MEDICARE PROVIDER #
GA
01
—
10033115
AMERIGROUP #
GA
01
—
883092643D
PEACH STATE #
GA
05
—
883092643D
—
GA
Enumeration date
01/02/2007
Last updated
07/16/2021
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