Individual
CHARLES E HICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
140 NORTH ST, CLEVELAND, MS 38732-2744
(662) 843-3668
(662) 846-1894
Mailing address
PO BOX 907, CLEVELAND, MS 38732-0907
(662) 843-3668
(662) 846-1984
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
80066
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00013450
—
MS
Enumeration date
09/20/2006
Last updated
07/08/2007
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