Provider Demographics
NPI:1528017951
Name:HICKS, JOHN R II (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:HICKS
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5046 HIGHWAY 17 BYP S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-4503
Mailing Address - Country:US
Mailing Address - Phone:843-293-5100
Mailing Address - Fax:843-293-5101
Practice Address - Street 1:5046 HIGHWAY 17 BYP S
Practice Address - Street 2:SUITE 100
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-4503
Practice Address - Country:US
Practice Address - Phone:843-293-5100
Practice Address - Fax:843-293-5101
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC14089174400000X, 207RI0011X, 207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC140895Medicaid
SCGP0749Medicaid
SC4433Medicare PIN
SCGP0749Medicaid