Provider Demographics
NPI:1821155854
Name:HICKS, LORETTA (MD)
Entity Type:Individual
Prefix:DR
First Name:LORETTA
Middle Name:
Last Name:HICKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:105 WING MILL RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-3142
Mailing Address - Country:US
Mailing Address - Phone:678-655-5018
Mailing Address - Fax:678-655-5306
Practice Address - Street 1:1000 HALSEY AVE SE BLDG 550
Practice Address - Street 2:NAS ATLANTA, NAVAL BRANCH HEALTH CLINIC-ATLANTA
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-4277
Practice Address - Country:US
Practice Address - Phone:678-655-5018
Practice Address - Fax:678-655-5306
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA021998207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine