Provider Demographics
NPI:1629188628
Name:HICKEY, JOSEPH T (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:T
Last Name:HICKEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 NEW ORLEANS ROAD
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29928-3572
Mailing Address - Country:US
Mailing Address - Phone:843-842-9960
Mailing Address - Fax:843-842-9963
Practice Address - Street 1:30 NEW ORLEANS RD
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29928-4715
Practice Address - Country:US
Practice Address - Phone:843-842-9960
Practice Address - Fax:843-842-9963
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17586207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCC07868Medicare UPIN