Provider Demographics
NPI:1649288226
Name:HICKS, JAMES A JR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:HICKS
Suffix:JR
Gender:M
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 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3314 PLATT SPRINGS RD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29170-2204
Practice Address - Country:US
Practice Address - Phone:803-791-3494
Practice Address - Fax:803-739-9854
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15673207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC156735Medicaid
SC156735Medicaid
SCF151494713Medicare PIN
SCF151496201Medicare PIN
SCF151496088Medicare PIN
SCF151496125Medicare PIN