Healthcare Provider Details

I. General information

NPI: 1568392108
Provider Name (Legal Business Name): THOMAS CARLTON HICKS MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7410 EWELL RD
MECHANICSVILLE VA
23111-1637
US

IV. Provider business mailing address

7410 EWELL RD
MECHANICSVILLE VA
23111-1637
US

V. Phone/Fax

Practice location:
  • Phone: 941-307-9975
  • Fax:
Mailing address:
  • Phone: 941-307-9975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number16965
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: