Provider Demographics
NPI:1730150293
Name:VICK, GEORGE WILSON II (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WILSON
Last Name:VICK
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 19TH ST STE 304
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1839
Mailing Address - Country:US
Mailing Address - Phone:865-522-2229
Mailing Address - Fax:865-546-8355
Practice Address - Street 1:501 19TH ST STE 304
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1839
Practice Address - Country:US
Practice Address - Phone:865-522-2229
Practice Address - Fax:865-546-8355
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTNMD14697207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3700996Medicaid
TN3700996Medicaid
TN3700996Medicare ID - Type Unspecified