Individual
NANDAN RAMESH HICHKAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
840 PINE ST, SUITE 880, MACON, GA 31201
(478) 743-7092
(478) 743-6293
Mailing address
160 DEER RIDGE TRL, MACON, GA 31210-5713
(478) 743-7092
(478) 743-7320
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
2503
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100002797A
—
GA
Enumeration date
05/25/2006
Last updated
01/13/2022
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