Shannon T. Hicks, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME140317 Issued in FL

Practice address

2302 Parklake Dr NE
Atlanta, GA 30345-2896

Phone

(678) 894-0288

NPI assigned

Jun 29, 2016

Last updated

Jun 9, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: shicks504354@directwellstar.org

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.

• Wellstar Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Marietta, GA
  • NPI 1275992240
  NPD
• New Interlachen Pediatrics, P.a.

  • Pediatrics Physician
  • Maitland, FL
  • NPI 1659380459
  NPD (past)
• Thomas a Fisk MD

  • Non-Pharmacy Dispensing Site
  • Maitland, FL
  • NPI 1376589481
  NPD (past)

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

{
    "created_epoch": "1467158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623196800000",
    "number": "1790136901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 DEERFIELD CROSSING DR APT 2113",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300041803",
            "telephone_number": "252-529-3544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2302 PARKLAKE DR NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303452896",
            "telephone_number": "678-894-0288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKS",
        "first_name": "SHANNON",
        "middle_name": "T.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-29",
        "last_updated": "2021-06-09",
        "certification_date": "2021-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME140317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimani Hicks
• Lauri A Hicks, DO
• Lorraine D Hicks, NP
• Melanie Charisse Hicks, PAA
• Natalie Eve Hicks, PA-C
• Theodosia Hicks
• William Harrison Hicks, MD
• Michael Hickson, MD
• Tatiana Hickson
• Hidden Gems ABA Ga LLC

• Pediatrics Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.