MEDICARE: DR. KIMBERLY GRIFFIN HICKS M.D.

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	208000000X	Pediatrics Physician	MD34033	TN
2	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	MD34033	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	4034474	OTHER	TN	BLUE CROSS

General Provider Information

NPI Number	:	1467480327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY GRIFFIN HICKS M.D.

Provider Business Mailing Address
First Line	:	460 MEDICAL PARK DR
Second Line	:	SUITE 108
City	:	LENOIR CITY
State	:	TN
Zip	:	37772-5782
Country	:	US
Telephone Number	:	865-271-9536
Fax Number	:	865-986-0212

Provider Business Practice Location Address
First Line	:	460 MEDICAL PARK DR
Second Line	:	SUITE 108
City	:	LENOIR CITY
State	:	TN
Zip	:	37772-5782
Country	:	US
Telephone Number	:	865-271-9536
Fax Number	:	865-986-0212

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	12/03/2012

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Directions to “ DR. KIMBERLY GRIFFIN HICKS M.D.” Practice Location

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