Provider Demographics
NPI:1033938550
Name:WILSON-VICKERS, DAMEKA RUNISE (CNM)
Entity type:Individual
Prefix:
First Name:DAMEKA
Middle Name:RUNISE
Last Name:WILSON-VICKERS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 TYNDALL DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1568
Mailing Address - Country:US
Mailing Address - Phone:229-237-7627
Mailing Address - Fax:
Practice Address - Street 1:3312 N OAK ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-1065
Practice Address - Country:US
Practice Address - Phone:229-433-8526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332253176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife