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General NPI Number Information
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NPI Number | 1467959288
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Entity Type | Individual
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Provider Name | HARRY EUGENE HICKLIN IV
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Gender | Male
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Dates
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Enumeration Date | 04/09/2018
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 2728 SUNSET BLVD STE 300
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-4815
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Country | US
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Telephone | 803-744-4900
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Fax | 803-744-4938
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Provider Business Mailing Address
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Address Line | WAKE FOREST BAPTIST MEDICAL CENTER GME OFFICE
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City | WINSTON SALEM
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State | NC
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Zip | 27157-0001
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Country | US
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Telephone | 336-716-5222
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 94062
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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