Provider Demographics
NPI:1033152988
Name:HICKEY, JUDSON STEPHEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUDSON
Middle Name:STEPHEN
Last Name:HICKEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 CENTRAL AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-6272
Mailing Address - Country:US
Mailing Address - Phone:706-739-0071
Mailing Address - Fax:706-739-0820
Practice Address - Street 1:2315 CENTRAL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6272
Practice Address - Country:US
Practice Address - Phone:706-739-0071
Practice Address - Fax:706-739-0820
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0091671223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics