Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | 79477 | GA |
NPI | 1558559906 |
---|---|
Provider Name | Brian Vickery |
First Address | Atlanta, GA 30329-2309 |
Second Address | Atlanta, GA 30329-2309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2007 |
Last Update Date | 25/06/2021 |