Provider Demographics
NPI:1255951604
Name:HICKS, ALANDRA UNIQUE
Entity type:Individual
Prefix:
First Name:ALANDRA
Middle Name:UNIQUE
Last Name:HICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7027 BRANCH CROSSING WAY
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-7041
Mailing Address - Country:US
Mailing Address - Phone:770-990-7383
Mailing Address - Fax:
Practice Address - Street 1:7027 BRANCH CROSSING WAY
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-7041
Practice Address - Country:US
Practice Address - Phone:770-990-7383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN100121164W00000X
OH171711164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH171711OtherLPN LICENSE NUMBER