Provider Demographics
NPI:1811035850
Name:POWE VICKERS, SUZANNE (PA)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:
Last Name:POWE VICKERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 SUTHERLAND PL
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-2330
Mailing Address - Country:US
Mailing Address - Phone:205-515-9354
Mailing Address - Fax:205-592-3999
Practice Address - Street 1:972 MONTCLAIR RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1204
Practice Address - Country:US
Practice Address - Phone:205-592-4880
Practice Address - Fax:205-592-3999
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRA-1119363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical