Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DN008423 | GA |
NPI | 1376503508 |
---|---|
Provider Name | Dr. Harry T Hickson |
First Address | Savannah, GA 31406-3905 |
Second Address | Savannah, GA 31406-3905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 09/07/2007 |