Provider Demographics
NPI:1134171440
Name:HICKMAN, CARY STANLEY (MD)
Entity type:Individual
Prefix:DR
First Name:CARY
Middle Name:STANLEY
Last Name:HICKMAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:888-472-0043
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:615 WESLEY DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407
Practice Address - Country:US
Practice Address - Phone:843-571-6880
Practice Address - Fax:843-571-6880
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15632207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC110181901OtherRAILROAD CARE
SC156324Medicaid
SC110147633OtherRAILROAD MEDICARE
SCP00727245OtherRAILROAD MEDICARE ID-RSFPN
SCI288754958Medicare UPIN
SCF901099223Medicare PIN
SC1497874424Medicare PIN
SC1760432298Medicare PIN
SC110147633OtherRAILROAD MEDICARE