Provider Demographics
NPI:1235298548
Name:HICKS, SHARON DENISE (RN)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:DENISE
Last Name:HICKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3342 RIVER MILL LN
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-1300
Mailing Address - Country:US
Mailing Address - Phone:404-244-8856
Mailing Address - Fax:
Practice Address - Street 1:2277 STONE MOUNTAIN LITHONIA RD
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-5252
Practice Address - Country:US
Practice Address - Phone:770-484-2600
Practice Address - Fax:770-484-0155
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN110745163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse