Provider Demographics
NPI:1740236314
Name:HICHKAD, NANDAN RAMESH
Entity Type:Individual
Prefix:
First Name:NANDAN
Middle Name:RAMESH
Last Name:HICHKAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NANDAN
Other - Middle Name:RAMESH
Other - Last Name:HICHKAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:160 DEER RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-5713
Mailing Address - Country:US
Mailing Address - Phone:478-743-7092
Mailing Address - Fax:478-743-7320
Practice Address - Street 1:840 PINE ST
Practice Address - Street 2:SUITE 880
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201
Practice Address - Country:US
Practice Address - Phone:478-743-7092
Practice Address - Fax:478-743-6293
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2503363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100002797AMedicaid
GA100002797AMedicaid
GAP00124928Medicare UPIN