Healthcare Provider Details

I. General information

NPI: 1871466458
Provider Name (Legal Business Name): BRIAN FICKLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 WOODFIELD DR
MACON GA
31210-5625
US

IV. Provider business mailing address

314 HEARTHWOOD DR
KATHLEEN GA
31047-3107
US

V. Phone/Fax

Practice location:
  • Phone: 478-475-7988
  • Fax:
Mailing address:
  • Phone: 478-475-7988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number000744
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: