Healthcare Provider Details

I. General information

NPI: 1447837091
Provider Name (Legal Business Name): KRISTIN MARIE ATES HICKS MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2021
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 PROVIDENCE PARK DR E
MOBILE AL
36695-4617
US

IV. Provider business mailing address

411 N SECTION ST
FAIRHOPE AL
36532-2649
US

V. Phone/Fax

Practice location:
  • Phone: 251-990-3937
  • Fax: 251-990-9990
Mailing address:
  • Phone: 251-990-3937
  • Fax: 251-990-9990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD.50610
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: