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General NPI Number Information
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NPI Number | 1114435690
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Entity Type | Organization
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Legal Business Name | HICKHAM DERMATOLOGY AND MED SPA LLC
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Dates
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Enumeration Date | 01/18/2018
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Last Update Date | 01/23/2018
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Provider Practice Location Address
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Address Line | 4141 BIENVILLE ST STE 108
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City | NEW ORLEANS
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State | LA
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Zip | 70119-5149
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Country | US
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Telephone | 504-258-0244
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Fax |
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Provider Business Mailing Address
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Address Line | 4141 BIENVILLE ST STE 108
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City | NEW ORLEANS
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State | LA
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Zip | 70119-5149
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/MD
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Name | MRS. PATRICIA RICE HICKHAM
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Credential | MD
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Telephone | 504-258-0244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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