Healthcare Provider Details

I. General information

NPI: 1477991834
Provider Name (Legal Business Name): MICHELLE LYNETTE VICK RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W MONTGOMERY XRD
SAVANNAH GA
31406-3309
US

IV. Provider business mailing address

109 BEE ST
CHARLESTON SC
29401-5703
US

V. Phone/Fax

Practice location:
  • Phone: 912-920-0214
  • Fax:
Mailing address:
  • Phone: 912-920-0214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number4150
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: