Brandon Hicks, M.D.
Individual provider Active NPI Emergency Medicine Physician · Athens, GA
NPI 1104804491 · NPPES record last updated Nov 8, 2007
Key facts
- NPI
- 1104804491
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 46683 (GA)
- Practice address
- 1230 Baxter St
Athens, GA 30606-3712 - Phone
- (706) 543-3449
- NPI assigned
- Jan 6, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Emergency Medicine
- Education
- Medical College of Georgia School of Medicine, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Athens Clarke Medical Enterprises LLC
Practice addresses (Care Compare)
1230 Baxter St
Athens, GA 30606-3712
Phone (706) 389-3000
Hospital & facility affiliations
- St Mary'S Hospital
- St Marys Good Samaritan Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041202000671 | GA | Practitioner - Emergency Medicine | 8921064841 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 46683 | GA | MD | Emergency Medicine Physician |
| 046883 | GA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Athens Clarke Medical Enterprises LLC | Emergency Medicine | Current |
Accepting new patients |
| Athens Clarke Medical Enterprises LLC | Emergency Medicine | Current |
Accepting new patients |
Locations
1230 Baxter St
Athens, GA 30606
Phone (706) 364-3100
5401 Lake Oconee Pkwy
Greensboro, GA 30642
Phone (706) 453-7331
Interoperability endpoints
- https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4
- bhicks2018346@direct.trinity-health.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 46683 | GA | Yes |
Addresses
Primary practice location
1230 Baxter St
Athens, GA 30606-3712
Mailing address
PO Box 48298
Athens, GA 30604-8298
Phone (706) 543-3449
Other providers in Athens, GA
- Jubilee Grace Herrs
- Joyce Elizabeth Hethcox
- Peter Heusner
- Dylan Mawulom Yaw Hewlett
- Hi-Tech Healthcare Inc.
- Danielle Marie Hicks
- Melody Jane Higginbotham
- Ethel Anne Higgins-Harris
- Marian Higgins
- Olympia High
All providers in Athens, GA · Emergency Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.