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General NPI Number Information
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NPI Number | 1538347398
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Entity Type | Organization
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Legal Business Name | KEVIN B. HICKS, D.O.,P.C.
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Dates
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Enumeration Date | 02/04/2008
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Last Update Date | 03/27/2019
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Provider Practice Location Address
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Address Line | 6105 PEACHTREE DUNWOODY RD STE C115
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City | ATLANTA
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State | GA
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Zip | 30328-5943
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Country | US
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Telephone | 770-481-0019
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Fax | 770-481-0408
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Provider Business Mailing Address
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Address Line | 6105 PEACHTREE DUNWOODY RD STE C115
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City | ATLANTA
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State | GA
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Zip | 30328-5943
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Country | US
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Telephone | 770-481-0019
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Fax | 770-481-0408
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. KEVIN B. HICKS
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Credential | D.O.
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Telephone | 770-481-0019
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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 | 52959
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License Number State | GA
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