Provider Demographics
NPI:1669522496
Name:VICKERS, JAMES E JR (PA-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:VICKERS
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:JED
Other - Middle Name:
Other - Last Name:VICKERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:169 WAGON WHEEL DR
Mailing Address - Street 2:
Mailing Address - City:ELLERSLIE
Mailing Address - State:GA
Mailing Address - Zip Code:31807-5381
Mailing Address - Country:US
Mailing Address - Phone:706-243-4500
Mailing Address - Fax:706-243-4503
Practice Address - Street 1:2121 WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-7955
Practice Address - Country:US
Practice Address - Phone:706-243-4500
Practice Address - Fax:706-243-4503
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004578363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant