Healthcare Provider Details

I. General information

NPI: 1033643390
Provider Name (Legal Business Name): ALEXANDER HICKS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 RESERVE BLVD STE 200
SPRING HILL TN
37174-3274
US

IV. Provider business mailing address

100 BLYTHEWOOD DR STE A
COLUMBIA TN
38401-4828
US

V. Phone/Fax

Practice location:
  • Phone: 615-302-5000
  • Fax: 615-302-5006
Mailing address:
  • Phone: 901-238-7031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD0000059420
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: