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Individual

MS. VICKIE L BOUCHILLON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
1968 PEACHTREE RAOD NW, ATLANTA, GA 30309-1218
(678) 202-2074
(770) 590-1442
Mailing address
PO BOX 551420, FORT LAUDERDALE, FL 33355-1420
(800) 243-3839
(954) 839-2569

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN039767
GA
367500000X
Certified Registered Nurse Anesthetist
Primary
RN039767
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000718825J
GA
Enumeration date
07/15/2006
Last updated
04/12/2026
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