Individual
MARY C HICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1860 PENNSYLVANIA AVE, MCDONOUGH, GA 30253-9117
(678) 462-1342
Mailing address
709 CRESCENT CIR, CANTON, GA 30115-4772
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
2251P0200X
Pediatric Physical Therapist
—
—
Other
Enumeration date
05/07/2012
Last updated
05/07/2012
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