Provider Demographics
NPI:1821059593
Name:HICKS, MELISSA MAXINE (MD)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:MAXINE
Last Name:HICKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:119 HENDERSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2868
Mailing Address - Country:US
Mailing Address - Phone:828-257-4725
Mailing Address - Fax:828-232-2953
Practice Address - Street 1:123 HENDERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803
Practice Address - Country:US
Practice Address - Phone:828-257-4730
Practice Address - Fax:828-257-4738
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC29591207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1821059593Medicaid
NC207252DMedicare PIN
NC1821059593Medicaid