Provider Demographics
NPI:1164556957
Name:GATWOOD, VICKI B (CFM)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:B
Last Name:GATWOOD
Suffix:
Gender:F
Credentials:CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 2ND ST NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-2660
Mailing Address - Country:US
Mailing Address - Phone:828-327-3344
Mailing Address - Fax:828-327-3834
Practice Address - Street 1:1239 2ND ST NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-2660
Practice Address - Country:US
Practice Address - Phone:828-327-3344
Practice Address - Fax:828-327-3834
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795268Medicaid