Provider Demographics
NPI:1356783245
Name:HICKS, CLARENCE
Entity type:Individual
Prefix:
First Name:CLARENCE
Middle Name:
Last Name:HICKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 SUMMER GROVE LN
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-5234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 HAMILTON POINTE DR
Practice Address - Street 2:SUITE 115 & 120
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008
Practice Address - Country:US
Practice Address - Phone:478-477-7531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management