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General NPI Number Information
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NPI Number | 1891372199
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Entity Type | Individual
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Provider Name | ROBERT FAVROT VICKERS MD
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Gender | Male
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Dates
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Enumeration Date | 03/24/2021
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 3925 PEACHTREE RD NE STE 300
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City | BROOKHAVEN
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State | GA
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Zip | 30319-5257
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Country | US
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Telephone | 770-400-7700
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Fax | 770-254-6109
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Provider Business Mailing Address
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Address Line | 3925 PEACHTREE RD NE STE 300
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City | BROOKHAVEN
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State | GA
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Zip | 30319-5257
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Country | US
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Telephone | 770-400-7700
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Fax | 770-254-6109
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 46806
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 101650
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License Number State | GA
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