Provider Demographics
NPI:1689464430
Name:VICKERS, SABRINA
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:VICKERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LENOX POINTE NE
Mailing Address - Street 2:STE A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3103
Mailing Address - Country:US
Mailing Address - Phone:678-824-6590
Mailing Address - Fax:
Practice Address - Street 1:50 LENOX POINTE NE
Practice Address - Street 2:STE A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324
Practice Address - Country:US
Practice Address - Phone:678-824-6590
Practice Address - Fax:678-228-1258
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty