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General NPI Number Information
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NPI Number | 1356966717
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Entity Type | Individual
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Provider Name | LORRAINE D HICKS NP
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Gender | Female
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Dates
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Enumeration Date | 06/11/2020
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 3478 LAKESIDE DR NE UNIT 1004
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City | ATLANTA
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State | GA
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Zip | 30326-1859
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Country | US
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Telephone | 404-662-8902
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Fax |
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Provider Business Mailing Address
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Address Line | 1144 E STAFFORD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19138-1831
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | SP021532
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License Number State | PA
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