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General NPI Number Information
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NPI Number | 1235392408
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Entity Type | Organization
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Legal Business Name | WINNIE CLAIRE HICKS
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 162 MEMORIAL DR
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City | JESUP
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State | GA
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Zip | 31545-0101
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Country | US
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Telephone | 912-588-2511
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Fax | 912-588-2518
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Provider Business Mailing Address
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Address Line | 162 MEMORIAL DR
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City | JESUP
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State | GA
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Zip | 31545-0101
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Country | US
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Telephone | 912-588-2511
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Fax | 912-588-2518
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | WINNIE CLAIRE HICKS
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Credential | M.D.
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Telephone | 912-588-2511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 029466
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License Number State | GA
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