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General NPI Number Information
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NPI Number | 1790568905
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Entity Type | Individual
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Provider Name | TINA MARIE HICKS-GREENWAY A-GNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/14/2023
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 1075 S MAIN ST STE 400
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City | MADISON
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State | GA
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Zip | 30650-2050
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Country | US
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Telephone | 706-818-3865
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Fax | 866-385-9163
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Provider Business Mailing Address
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Address Line | 1141 BRIAR LN
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City | MADISON
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State | GA
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Zip | 30650-3901
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Country | US
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Telephone | 706-818-3865
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Fax | 866-385-9163
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN298533
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | RN298533
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN298533
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License Number State | GA
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