Individual
HARRY EUGENE HICKLIN III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
430 S HERLONG AVE, SUITE 104, ROCK HILL, SC 29732-1094
(803) 324-4900
(803) 324-1155
Mailing address
430 S HERLONG AVE, SUITE 104, ROCK HILL, SC 29732-1094
(803) 324-4900
(803) 324-1155
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
14159
SC
207R00000X
Internal Medicine Physician
25618
IA
207R00000X
Internal Medicine Physician
39615
NC
207RC0000X
Cardiovascular Disease Physician
Primary
14159
SC
207RC0000X
Cardiovascular Disease Physician
25618
IA
207RC0000X
Cardiovascular Disease Physician
39615
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
141590
—
SC
01
—
42145
BCBS
NC
05
—
8942145
—
NC
01
—
P00200607
RAILROAD MEDICARE
NC
01
—
P00204305
RAILROAD MEDICARE
SC
Enumeration date
08/12/2006
Last updated
08/17/2012
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