MEDICARE: DR. ANTHONY HICKS MD

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	207R00000X	Internal Medicine Physician	25571	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225022494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY HICKS MD

Provider Business Mailing Address
First Line	:	877 JEFFERSON AVE
Second Line	:	MOC LOOP ADMIN
City	:	MEMPHIS
State	:	TN
Zip	:	38103-2807
Country	:	US
Telephone Number	:	901-515-4529
Fax Number	:	901-515-4599

Provider Business Practice Location Address
First Line	:	1955 S 3RD ST
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38109-7713
Country	:	US
Telephone Number	:	901-515-5800
Fax Number	:	901-515-8590

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	02/04/2013

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