Provider Demographics
NPI:1558459958
Name:HICKS, ANNA M (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:M
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 1:12 KALIMAR HTS
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-6217
Mailing Address - Country:US
Mailing Address - Phone:828-290-4130
Mailing Address - Fax:
Practice Address - Street 1:510 BALSAM RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-5703
Practice Address - Country:US
Practice Address - Phone:828-693-4431
Practice Address - Fax:828-693-4434
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41581207R00000X, 207RH0002X
NC2009-00466207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3828816OtherMEDICARE