Physician Compare National (NPI:1932251253)

HEALTHCARE PROVIDER: SHERELL DENISE VICKS M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1932251253
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6709777634
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110830000359
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	VICKS
	Individual professional last name
Provider First Name	SHERELL
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	MEHARRY MEDICAL COLLEGE SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1988
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	5910 HILLANDALE DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 202
	Group Practice or individual's line 2 address
City	LITHONIA
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	300581877
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	110226
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	DEKALB MEDICAL CENTER AT HILLANDALE
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	110076
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	DEKALB MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y