Provider Demographics
NPI:1477802585
Name:HICKS, JAMES E (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:HICKS
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 1:1090 NORTHCHASE PKWY SE, STE 290
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067
Mailing Address - Country:US
Mailing Address - Phone:678-904-5665
Mailing Address - Fax:678-904-5665
Practice Address - Street 1:625 HIGHWAY 28 BYP
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29624-3009
Practice Address - Country:US
Practice Address - Phone:678-904-5665
Practice Address - Fax:678-904-5665
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8139122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice