Healthcare Provider Details

I. General information

NPI: 1720199110
Provider Name (Legal Business Name): DANIKA YVETTE HICKMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 SAINT VINCENTS DR
BIRMINGHAM AL
35205-1601
US

IV. Provider business mailing address

810 SAINT VINCENTS DR
BIRMINGHAM AL
35205-1601
US

V. Phone/Fax

Practice location:
  • Phone: 205-930-2456
  • Fax: 205-930-2469
Mailing address:
  • Phone: 205-930-2456
  • Fax: 205-930-2469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00023665
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: