Healthcare Provider Details

I. General information

NPI: 1104359314
Provider Name (Legal Business Name): DR. VICK DICARLO II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 7TH ST SE STE 140
DECATUR AL
35601-3394
US

IV. Provider business mailing address

1215 7TH ST SE STE 140
DECATUR AL
35601-3394
US

V. Phone/Fax

Practice location:
  • Phone: 256-973-3225
  • Fax: 256-301-3860
Mailing address:
  • Phone: 256-973-3225
  • Fax: 256-301-3860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number37659
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: