Individual
DR. JUSTIN HICKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5115 BERNARD DR STE 201, ROANOKE, VA 24018-4367
(540) 345-0289
(540) 345-9569
Mailing address
1215 LEE ST, BOX 800710, CHARLOTTESVILLE, VA 22908-0816
(434) 982-0629
(434) 982-0019
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
0101272390
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942731575
—
VA
05
—
1942731575
—
WV
Enumeration date
03/24/2017
Last updated
06/29/2021
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