NPIMap

Individual provider Active NPI

Sherell Denise Vicks, M.D.

  • Internal Medicine Physician
  • Lithonia, GA
National Provider Identifier
1932251253
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
034265 Issued in GA
Practice address
5910 Hillandale Dr
Suite 202
Lithonia, GA 30058-1884
Phone
(770) 808-0092
Fax
(770) 808-0380
NPI assigned
Jan 17, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 034265 GA Primary

Addresses

Primary practice location

5910 Hillandale Dr
Suite 202
Lithonia, GA 30058-1884

Mailing address

5910 Hillandale Dr
Suite 202
Lithonia, GA 30058-1884
Phone (770) 808-0092

Other identifiers 1

IdentifierTypeStateIssuer
00641935CMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110830000359 GA Practitioner - Internal Medicine 6709777634 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Meharry Medical College School of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5910 Hillandale Dr
Suite 204
Lithonia, GA 30058-1878
Phone (770) 808-0092

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
034265GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hillandale Medical Associates, PC Internal Medicine CurrentSince Feb 1, 2001 Accepting new patients

Locations

5910 Hillandale Dr
Ste 202
Lithonia, GA 30058
Phone (770) 808-0092

5910 Hillandale Dr
Ste 204
Lithonia, GA 30058
Phone (770) 808-0092

Interoperability endpoints

  • Direct secure messaging: sherell.vicks@718104263393284.direct.elationemr.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1932251253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5910 HILLANDALE DR",
            "address_2": "SUITE 202",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300581884",
            "telephone_number": "770-808-0092",
            "fax_number": "770-808-0380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5910 HILLANDALE DR",
            "address_2": "SUITE 202",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300581884",
            "telephone_number": "770-808-0092",
            "fax_number": "770-808-0380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICKS",
        "first_name": "SHERELL",
        "middle_name": "DENISE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "034265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00641935C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lithonia, GA

Sources for this page

Verify at the official NPI Registry.