Vickers, Stacee

Vickers, Stacee is an sole proprietor health care provider with primary practice located at 318 W Pike St Suite 104, Lawrenceville GA 30045-3234. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Pediatrics, which is considered as her primary health care specialty. Vickers, Stacee can be contacted via phone (678) 377-2833.

Contact Information

Primary practice address
318 W Pike St Suite 104 Lawrenceville GA 30045-3234
Phone: (678) 377-2833
Fax: (678) 377-2882
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Pediatrics 2251P0200X 004817 Georgia

Profile Details

NPI number 1386711067
LBN Legal business name Vickers, Stacee
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 29th, 2006
Last updated Jul 9th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1386711067 NPPES
Georgia Other 307933 WELLCARE PROVIDER #
Georgia MEDICAID 00776993D WELLCARE PROVIDER #
Georgia Other 10037646 WELLCARE PROVIDER #

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