Healthcare Provider Details

I. General information

NPI: 1023422888
Provider Name (Legal Business Name): ARMAN CICIC D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 LAWRENCEVILLE SUWANEE RD STE 101
LAWRENCEVILLE GA
30043-5483
US

IV. Provider business mailing address

1930 BRANNAN RD
MCDONOUGH GA
30253-4310
US

V. Phone/Fax

Practice location:
  • Phone: 770-963-2451
  • Fax: 770-962-0017
Mailing address:
  • Phone: 678-284-4040
  • Fax: 678-284-4076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number102557
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: