Healthcare Provider Details

I. General information

NPI: 1114884715
Provider Name (Legal Business Name): JOANNA HICKS CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 CARIBBEAN VILLAGE DR
GUYTON GA
31312-7541
US

IV. Provider business mailing address

240 CARIBBEAN VILLAGE DR
GUYTON GA
31312-7541
US

V. Phone/Fax

Practice location:
  • Phone: 912-410-4307
  • Fax:
Mailing address:
  • Phone: 912-410-4307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: