Provider Demographics
NPI:1801178033
Name:RICKS, NATALIE N (PA-C)
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:N
Last Name:RICKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:NATALIE
Other - Middle Name:N
Other - Last Name:RICKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:136 BATTLEFIELD CROSSING CT
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-5176
Mailing Address - Country:US
Mailing Address - Phone:706-277-7311
Mailing Address - Fax:706-529-7210
Practice Address - Street 1:1107 MEMORIAL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8668
Practice Address - Country:US
Practice Address - Phone:706-277-7311
Practice Address - Fax:706-272-3512
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200490363A00000X
TN3087363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2167731Medicaid
LA5F600PF54OtherMEDICARE - PTAN