Individual
JASON HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6919 OLD CANTON RD, RIDGELAND, MS 39157-1268
(601) 956-0911
(601) 957-8439
Mailing address
6919 OLD CANTON RD, RIDGELAND, MS 39157-1268
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
18937
MS
208000000X
Pediatrics Physician
18937
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0629768
—
MS
Enumeration date
07/14/2006
Last updated
12/27/2013
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