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General NPI Number Information
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NPI Number | 1386840841
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Entity Type | Individual
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Provider Name | LISA HICHKAD NCCPA
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Gender | Female
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 210 MERCER JCT
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City | MACON
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State | GA
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Zip | 31210-4016
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Country | US
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Telephone | 478-471-8593
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Fax | 478-471-8599
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Provider Business Mailing Address
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Address Line | 160 DEER RIDGE TRL
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City | MACON
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State | GA
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Zip | 31210-5713
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Country | US
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Telephone | 478-476-9174
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 002499
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License Number State | GA
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