Provider Demographics
NPI:1679789861
Name:VICKERY, DAVID AUGUSTUS (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:AUGUSTUS
Last Name:VICKERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 YORKSHIRE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-7783
Mailing Address - Country:US
Mailing Address - Phone:828-274-1600
Mailing Address - Fax:828-274-1603
Practice Address - Street 1:15 YORKSHIRE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-7783
Practice Address - Country:US
Practice Address - Phone:828-274-1600
Practice Address - Fax:828-274-1603
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200201416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2030977AOtherMEDICARE ID
NC89137RTMedicaid
NC89137RTMedicaid
NCI14006Medicare UPIN