Healthcare Provider Details

I. General information

NPI: 1922363662
Provider Name (Legal Business Name): CASEY HICKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 9TH AVE SW STE 310
BESSEMER AL
35022-7839
US

IV. Provider business mailing address

405 BELCHER ST.
CENTREVILLE AL
35042
US

V. Phone/Fax

Practice location:
  • Phone: 205-277-2358
  • Fax: 205-426-7799
Mailing address:
  • Phone: 205-926-2992
  • Fax: 205-316-7675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.35273
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: