Individual
HOLLY HICKS-DERIDDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2700 HIGHWAY 34 E BLDG 300, NEWNAN, GA 30265-1330
(770) 304-0987
(770) 251-0938
Mailing address
2700 HIGHWAY 34 E BLDG 300, NEWNAN, GA 30265-1330
(770) 304-0987
(770) 251-0938
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
003338
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100002196A
—
GA
Enumeration date
11/02/2006
Last updated
11/01/2011
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