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General NPI Number Information
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NPI Number | 1821155854
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Entity Type | Individual
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Provider Name | LORETTA HICKS M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1000 HALSEY AVE SE BLDG 550 NAS ATLANTA, NAVAL BRANCH HEALTH CLINIC-ATLANTA
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City | MARIETTA
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State | GA
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Zip | 30060-4277
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Country | US
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Telephone | 678-655-5018
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Fax | 678-655-5306
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Provider Business Mailing Address
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Address Line | 105 WING MILL RD
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City | ATLANTA
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State | GA
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Zip | 30350-3142
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Country | US
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Telephone | 678-655-5018
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Fax | 678-655-5306
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 021998
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License Number State | GA
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