Provider Demographics
NPI:1780663807
Name:HICKS, WATERS MERRILL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WATERS
Middle Name:MERRILL
Last Name:HICKS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:334 SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-5533
Mailing Address - Country:US
Mailing Address - Phone:229-227-1595
Mailing Address - Fax:229-227-1385
Practice Address - Street 1:334 SMITH AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5533
Practice Address - Country:US
Practice Address - Phone:229-227-1595
Practice Address - Fax:229-227-1385
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA38251207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000594811HMedicaid
GA000594811QMedicaid
GA000594811OMedicaid
GA000594811PMedicaid
GA000594811AMedicaid
GA000594811GMedicaid
GA000594811JMedicaid
GA000594811KMedicaid
GA000594811LMedicaid
GA000594811DMedicaid
GA000594811PMedicaid
GA000594811HMedicaid