Individual
D MARK HICKLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
120 HEYWOOD AVE, SUITE 200, SPARTANBURG, SC 29302-1210
(864) 573-9595
(864) 585-3752
Mailing address
PO BOX 2168, SPARTANBURG, SC 29304-2168
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11179
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111792
—
SC
01
—
4584043
AETNA
SC
01
—
58864
MEDCOST
SC
05
—
7906539
—
NC
Enumeration date
01/25/2006
Last updated
12/13/2007
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