Healthcare Provider Details

I. General information

NPI: 1477661635
Provider Name (Legal Business Name): CHRISTOPHER JOE HICKS C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

993-D JOHNSON FERRY RD. SUITE 300
ATLANTA GA
30342
US

IV. Provider business mailing address

110 STARBOARD WAY
ALPHARETTA GA
30022-4499
US

V. Phone/Fax

Practice location:
  • Phone: 404-250-1153
  • Fax:
Mailing address:
  • Phone: 404-578-5263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN137958
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: