Organization
MILL CREEK CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHERYL BAILEY VICKERY M.D (OWNER)
(770) 378-0328
Entity
Organization
Contact information
Practice address
7824 HICKORY FLAT HWY STE 120, WOODSTOCK, GA 30188-6575
(770) 604-1930
(770) 604-1929
Mailing address
6175 HICKORY FLAT HWY, STE 110-343, CANTON, GA 30115-7207
(770) 704-4911
(770) 704-4922
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
26446
GA
261QP2300X
Primary Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
883092643D
—
GA
Enumeration date
02/23/2015
Last updated
03/19/2019
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