Provider Demographics
NPI:1649660192
Name:HICKS, ROBERT (FNP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:HICKS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 OLD NORCROSS RD
Mailing Address - Street 2:SUITE 185
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3393
Mailing Address - Country:US
Mailing Address - Phone:770-277-8554
Mailing Address - Fax:770-277-1799
Practice Address - Street 1:748 OLD NORCROSS RD
Practice Address - Street 2:SUITE 185
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3393
Practice Address - Country:US
Practice Address - Phone:770-277-8554
Practice Address - Fax:770-277-1799
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA158733363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily