Provider Demographics
NPI:1588986335
Name:VICKERY, BRIAN SCOTT (CRNA)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:SCOTT
Last Name:VICKERY
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Gender:M
Credentials:CRNA
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Mailing Address - Street 1:3025 HIGHWAY 154
Mailing Address - Street 2:BLDG B
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-6121
Mailing Address - Country:US
Mailing Address - Phone:770-251-2060
Mailing Address - Fax:770-251-8567
Practice Address - Street 1:1514 VERNON RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4131
Practice Address - Country:US
Practice Address - Phone:706-882-1411
Practice Address - Fax:706-845-3459
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2021-01-27
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Provider Licenses
StateLicense IDTaxonomies
GARN204160367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered