Healthcare Provider Details

I. General information

NPI: 1144185810
Provider Name (Legal Business Name): MATTHEW HICKS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5722 CLARION ST
CUMMING GA
30040-0306
US

IV. Provider business mailing address

4951 MARK JOHN WAY
CUMMING GA
30040-6427
US

V. Phone/Fax

Practice location:
  • Phone: 470-252-7889
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018137
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: