Individual
DR. MICHAEL HICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1270 CAROLINE ST NE, SUITE D120-123, ATLANTA, GA 30307-2758
(404) 829-5953
Mailing address
1270 CAROLINE ST NE, SUITE D120-123, ATLANTA, GA 30307-2758
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101043842
VA
207R00000X
Internal Medicine Physician
175951
NY
207R00000X
Internal Medicine Physician
Primary
73009
GA
Other
Enumeration date
12/04/2014
Last updated
12/04/2014
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