Individual provider Active NPI

Anjanean Hicks, NP

  • Family Nurse Practitioner
  • Atlanta, GA
National Provider Identifier
1639524002
Registry record updated Jul 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN198259 Issued in GA
Practice address
2162 Piedmont Rd NE
Atlanta, GA 30224-2317
Phone
(770) 209-3663
NPI assigned
May 4, 2016
Last updated
Jul 6, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN198259 GA Primary

Addresses

Primary practice location

2162 Piedmont Rd NE
Atlanta, GA 30224-2317

Mailing address

2162 Piedmont Rd. NE
Atlanta, GA 30324-2317
Phone (707) 209-3663

Other identifiers 1

IdentifierTypeStateIssuer
NAOtherN/A

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL n/a

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160613000128 GA Practitioner - Nurse Practitioner 1850681388 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN198259GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
HMV Diagnostics CurrentSince Aug 23, 2019 Accepting new patients
Copilotiq, PC CurrentSince Jul 31, 2023 Accepting new patients
TLC of Georgia LLC Family CurrentSince May 3, 2016 Accepting new patients

Locations

2435 US Highway 19
Ste 300
Holiday, FL 34691
Phone (727) 940-5908

5304 Mile Stretch Dr
Holiday, FL 34690
Phone (727) 940-5908

3343 Peachtree Rd NE
Atlanta, GA 30326
Phone (615) 412-8777

3475 Lenox Rd NE
Ste 400
Atlanta, GA 30326
Phone (404) 601-2394

455 Nathan Dean Blvd
Dallas, GA 30132
Phone (770) 443-8776

4321 Hartley Bridge Rd
Macon, GA 31216
Phone (478) 788-1015

3600 Dallas Hwy SW
Marietta, GA 30064
Phone (770) 420-9170

2620 Elm Hill Pike
Nashville, TN 37214
Phone (615) 425-4211

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/22351/brand/1/csg/1/fhir/r4

Organizations & group practices 3

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": "1462320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657065600000",
    "number": "1639524002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2162 PIEDMONT RD. NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303242317",
            "telephone_number": "707-209-3663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2162 PIEDMONT RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "302242317",
            "telephone_number": "770-209-3663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKS",
        "first_name": "ANJANEAN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-04",
        "last_updated": "2022-07-06",
        "certification_date": "2022-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN198259",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "N/A",
            "identifier": "NA",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "n/a",
            "affiliation": "N",
            "address_1": "2162 Piedmont rd NE",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302242317",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.