Individual
RANDY LEE HICKS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
95 SULLIVAN LN, LA FAYETTE, GA 30728-1500
(423) 298-5079
Mailing address
95 SULLIVAN LN, LA FAYETTE, GA 30728-1500
(423) 298-5079
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10641
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/25/2021
Last updated
10/13/2021
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