Loretta Hicks, M.D.
Individual provider Active NPI Family Medicine Physician · Marietta, GA
NPI 1821155854 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1821155854
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 021998 (GA)
- Practice address
- 1000 Halsey Ave SE BLDG 550
Nas Atlanta, Naval Branch Health Clinic-Atlanta
Marietta, GA 30060-4277 - Phone
- (678) 655-5018
- Fax
- (678) 655-5306
- NPI assigned
- Jan 2, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| I20201118002906 | GA | Order and Referring Only - Family Practice |
0941611123 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021998 | GA | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 021998 | GA | Yes |
Addresses
Primary practice location
1000 Halsey Ave SE BLDG 550
Nas Atlanta, Naval Branch Health Clinic-Atlanta
Marietta, GA 30060-4277
Mailing address
105 Wing Mill Rd
Atlanta, GA 30350-3142
Phone (678) 655-5018
Other providers in Marietta, GA
- Hicks Counseling, LLC
- Anna Hicks
- Charles P Hicks
- Chase Hicks
- Jacob Hicks
- Victoria Marie Hicks
- Patricia Anne Higginbotham
- Highland Rivers Community Service Board
- Highlights Healthcare of Georgia, LLC
- William Ralph Hilbert
All providers in Marietta, GA · Family 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 Jul 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.