Healthcare Provider Details

I. General information

NPI: 1801019666
Provider Name (Legal Business Name): JOHN M HICKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 05/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 FLEMING ST
HENDERSONVILLE NC
28791-3528
US

IV. Provider business mailing address

800 FLEMING ST
HENDERSONVILLE NC
28791-3528
US

V. Phone/Fax

Practice location:
  • Phone: 828-698-4318
  • Fax: 828-698-4322
Mailing address:
  • Phone: 828-698-4318
  • Fax: 828-698-4322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number2009-00385
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number19233
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: