Provider Demographics
NPI:1144229824
Name:DRIGGERS, VICKI LYNN (NP)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:LYNN
Last Name:DRIGGERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:VICKI
Other - Middle Name:LYNN
Other - Last Name:DOTY-DRIGGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:10055 FORD AVE
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-3972
Mailing Address - Country:US
Mailing Address - Phone:912-756-2020
Mailing Address - Fax:912-756-3187
Practice Address - Street 1:10055 FORD AVE
Practice Address - Street 2:SUITE 5A
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3972
Practice Address - Country:US
Practice Address - Phone:912-756-2020
Practice Address - Fax:912-756-3187
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN090010363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000787916EMedicaid
SCNP0870Medicaid
SCNP0870Medicaid
GA000787916EMedicaid