Healthcare Provider Details

I. General information

NPI: 1891094967
Provider Name (Legal Business Name): WILLIAM LUKE HICKMAN P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 CAROLINA AVE
WASHINGTON NC
27889-3315
US

IV. Provider business mailing address

PO BOX 117594
ATLANTA GA
30368-7594
US

V. Phone/Fax

Practice location:
  • Phone: 252-946-2171
  • Fax: 252-946-5986
Mailing address:
  • Phone: 888-856-1878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number169518
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: