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RANDY LEE HICKS
>> Organized Health Care Education/Training Program >> StudentRegistrant NPI Number: 1841880655
Individual Registrant: RANDY LEE HICKS
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
95 SULLIVAN LN LA FAYETTE, GA 30728-1500 US
Tel: 423-298-5079 Fax: --
Tel: 423-298-5079 Fax: --
Contact information for business:
95 SULLIVAN LN LA FAYETTE, GA 30728-1500 US
Tel: 423-298-5079 Fax: --
Tel: 423-298-5079 Fax: --
Registration Information:
NPI: 1841880655
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 390200000X | Student Organized Health Care Education/Training Program | ||
| Y | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers Physician Assistant | GA | 10641 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
