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General NPI Number Information
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NPI Number | 1427270834
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Entity Type | Organization
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Legal Business Name | THE DAVID VICKERY LIMITED PARTNERSHIP
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3363 HIGHWAY 45 NORTH
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City | JACKSON
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State | TN
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Zip | 38305
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Country | US
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Telephone | 731-664-8444
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Fax |
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Provider Business Mailing Address
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Address Line | 3363 HIGHWAY 45 NORTH
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City | JACKSON
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State | TN
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Zip | 38305
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Country | US
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Telephone | 731-664-8444
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Fax |
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Authorized Official
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Title or Position | GENERAL PARTNER
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Name | DR. JOHN DAVID VICKERY
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Credential | PH.D.
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Telephone | 731-664-8444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | P1021
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License Number State | TN
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