Individual provider Active NPI

Daviea Antoinette Taylor-Hicks, PA-C

  • Medical Physician Assistant
  • Lawrenceville, GA
National Provider Identifier
1033141734
Registry record updated Aug 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
771 Old Norcross Rd
Lawrenceville, GA 30046-4386
Phone
(678) 802-4045
NPI assigned
Jul 6, 2006
Last updated
Aug 13, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 13, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X NU Primary

Addresses

Primary practice location

771 Old Norcross Rd
Lawrenceville, GA 30046-4386

Mailing address

771 Old Norcross Rd
Lawrenceville, GA 30046-4386
Phone (678) 802-4045

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250829003167 GA Practitioner - Physician Assistant 6608377718 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1989
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2866 Johnson Ferry Rd
Suite 200
Marietta, GA 30062-8349

4300 N Point Pkwy
Suite 300
Alpharetta, GA 30022-4102

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755043200000",
    "number": "1033141734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "771 OLD NORCROSS RD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300464386",
            "telephone_number": "678-802-4045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "771 OLD NORCROSS RD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300464386",
            "telephone_number": "678-802-4045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYLOR-HICKS",
        "first_name": "DAVIEA",
        "middle_name": "ANTOINETTE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-06",
        "last_updated": "2025-08-13",
        "certification_date": "2025-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.