MEDICARE: SHERYL B VICKERY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	026446	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	08BBSBL	OTHER	GA	MEDICARE PROVIDER #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	883092643D	OTHER	GA	PEACH STATE #
2	10033115	OTHER	GA	AMERIGROUP #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538226220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERYL B VICKERY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 5554
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-0290
Country	:	US
Telephone Number	:	470-410-7911
Fax Number	:	770-604-1929

Provider Business Practice Location Address
First Line	:	203 OAKSIDE LN STE C
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-6407
Country	:	US
Telephone Number	:	470-410-7911
Fax Number	:	770-604-1929

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/16/2021

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Directions to “ SHERYL B VICKERY M.D.” Practice Location

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