Provider Demographics
NPI:1003014507
Name:GEORGE W. VICK II M.D. P.C.
Entity Type:Organization
Organization Name:GEORGE W. VICK II M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:VICK
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:865-522-2229
Mailing Address - Street 1:817 E OLDHAM AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-5568
Mailing Address - Country:US
Mailing Address - Phone:865-522-2229
Mailing Address - Fax:865-546-8355
Practice Address - Street 1:817 E OLDHAM AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-5568
Practice Address - Country:US
Practice Address - Phone:865-522-2229
Practice Address - Fax:865-546-8355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000014697207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB58834Medicare UPIN