Healthcare Provider Details

I. General information

NPI: 1952072399
Provider Name (Legal Business Name): CYANA HICKS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2021
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6849 PEACHTREE DUNWOODY RD
ATLANTA GA
30328-1608
US

IV. Provider business mailing address

2135 GODBY RD APT 48-599
COLLEGE PARK GA
30349-3317
US

V. Phone/Fax

Practice location:
  • Phone: 678-821-5925
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License NumberRBT-21-181018
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: