Healthcare Provider Details

I. General information

NPI: 1396277927
Provider Name (Legal Business Name): BRIAN PATRICK VICKERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2017
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S ENOTA DR NE STE 480
GAINESVILLE GA
30501-3473
US

IV. Provider business mailing address

200 S ENOTA DR NE STE 480
GAINESVILLE GA
30501-3473
US

V. Phone/Fax

Practice location:
  • Phone: 770-534-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number103371
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number103371
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: