MEDICARE: AMY HICKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	RN216515	GA

General Provider Information

NPI Number	:	1033656962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY HICKS

Provider Business Mailing Address
First Line	:	104 ROME ST
Second Line	:
City	:	CARROLLTON
State	:	GA
Zip	:	30117-3103
Country	:	US
Telephone Number	:	404-301-4042
Fax Number	:	404-301-4042

Provider Business Practice Location Address
First Line	:	104 ROME ST
Second Line	:
City	:	CARROLLTON
State	:	GA
Zip	:	30117-3103
Country	:	US
Telephone Number	:	404-301-4042
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2017
Last Update Date	:	09/21/2022

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Directions to “ AMY HICKS ” Practice Location

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