Provider Demographics
NPI:1033141734
Name:TAYLOR-HICKS, DAVIEA ANTOINETTE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DAVIEA
Middle Name:ANTOINETTE
Last Name:TAYLOR-HICKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:250 N ARCADIA AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2115
Mailing Address - Country:US
Mailing Address - Phone:404-321-6111
Mailing Address - Fax:404-417-2903
Practice Address - Street 1:250 N ARCADIA AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2115
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:404-417-2903
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical