Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 029466 | GA |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 2010-00216 | NC |
NPI | 1326076787 |
---|---|
Provider Name | Ms. Winnie Claire Hicks |
First Address | Flat Rock, NC 28731-9447 |
Second Address | Flat Rock, NC 28731 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 22/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000369597A | (05) | GA |
022J | BCBS (01) | NC |
029466 | MEDICAL DOCTOR (01) | GA |
2010-00216 | MEDICAL DOCTOR (01) | NC |
238379 | BLUECROSS/BLUE SHIELD (01) | GA |
BH0901505 | DEA (01) | NC |
E00387 | (02) | GA |
GRP2943 | MEDICARE GRP (01) | GA |