Provider Demographics
NPI:1033544184
Name:IVEY, VICKIE J (LPN)
Entity Type:Individual
Prefix:MS
First Name:VICKIE
Middle Name:J
Last Name:IVEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 ROCKY PINE CT
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-2851
Mailing Address - Country:US
Mailing Address - Phone:770-808-6100
Mailing Address - Fax:770-808-7527
Practice Address - Street 1:3410 ROCKY PINE CT
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-2851
Practice Address - Country:US
Practice Address - Phone:770-808-6100
Practice Address - Fax:770-808-7527
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN032165164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse