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NPI Code Detail

MEDICARE: MRS. WMELVA AZIZA HICKMAN

MEDICARE: MRS. WMELVA AZIZA HICKMAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianGA

General Provider Information

NPI Number : 1619820222
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. WMELVA AZIZA HICKMAN
Provider Business Mailing Address
First Line : 3397 STONELEIGH WALK
Second Line :
City : STONECREST
State : GA
Zip : 30038-3298
Country : US
Telephone Number : 866-610-0580
Fax Number : 866-611-1558
Provider Business Practice Location Address
First Line : 300 INTERNATIONAL PKWY STE 200
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-5028
Country : US
Telephone Number : 866-610-0580
Fax Number : 866-611-1558
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2026
Last Update Date : 02/16/2026

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