Provider Demographics
NPI:1326076787
Name:HICKS, WINNIE CLAIRE (MD)
Entity Type:Individual
Prefix:MS
First Name:WINNIE
Middle Name:CLAIRE
Last Name:HICKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 S ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28731-9447
Mailing Address - Country:US
Mailing Address - Phone:828-692-6178
Mailing Address - Fax:828-692-6764
Practice Address - Street 1:571 S ALLEN RD
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:NC
Practice Address - Zip Code:28731
Practice Address - Country:US
Practice Address - Phone:828-692-6178
Practice Address - Fax:828-692-6764
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-00216207QH0002X
GA029466207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2010-00216OtherMEDICAL DOCTOR
GA238379OtherBLUECROSS/BLUE SHIELD
NC022JOtherBCBS
GA029466OtherMEDICAL DOCTOR
GAGRP2943OtherMEDICARE GRP
GA000369597AMedicaid
GA000369597AMedicaid