Organization
OPTIMUM PRIMARY CARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MACK LYNN HICKS M.D. (PHYSICIAN)
(423) 914-3195
Entity
Organization
Contact information
Practice address
444 CLINCHFIELD ST, SUITE 303, KINGSPORT, TN 37660-3606
(423) 914-3195
(423) 230-2818
Mailing address
444 CLINCHFIELD ST, SUITE 303, KINGSPORT, TN 37660-3606
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD0000015018
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3024432
—
TN
Enumeration date
03/25/2014
Last updated
03/25/2014
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