Individual
DR. SHERELL DENISE VICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5910 HILLANDALE DR, SUITE 202, LITHONIA, GA 30058-1884
(770) 808-0092
(770) 808-0380
Mailing address
5910 HILLANDALE DR, SUITE 202, LITHONIA, GA 30058-1884
(770) 808-0092
(770) 808-0380
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
034265
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00641935C
—
GA
Enumeration date
01/17/2007
Last updated
07/08/2007
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