Individual
WILLIAM LESLIE HICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
890 MADISON AVE, SUITE TG032, MEMPHIS, TN 38103-3409
(901) 448-2579
(901) 448-2602
Mailing address
890 MADISON AVE, SUITE TG032, MEMPHIS, TN 38103-3409
(901) 448-2579
(901) 448-2602
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
E-4374
AR
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
12709
TN
2086S0122X
Plastic and Reconstructive Surgery Physician
E-4374
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00154377
—
MS
05
—
003179306A
—
GA
05
—
1033209606
—
MO
05
—
111048001
—
AR
05
—
177555
—
AL
05
—
3001590
—
TN
Enumeration date
10/13/2006
Last updated
04/18/2025
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