Randy Lee Hicks Jr.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10641 Issued in GA

Practice address

95 Sullivan LN
La Fayette, GA 30728-1500

Phone

(423) 298-5079

NPI assigned

Jan 25, 2021

Last updated

Oct 13, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southland Consolidated Emergency Services LLCGroup PAC ID 2860792066, 68 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jefferson Hospital Hospital, Louisville, GA, CCN 110100

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Southland Consolidated Emergency Services, LLC

  • Emergency Medicine Physician
  • Elberton, GA
  • NPI 1174917124
  Medicare reassignment Care Compare group
• Hospital Authority of Washington County

  dba Washington County Regional Medical Center

  • Rural Acute Care Hospital
  • Sandersville, GA
  • NPI 1396770004
  Medicare reassignment
• Southland Behavioral Health Services LLC

  • Hospitalist Physician
  • Valdosta, GA
  • NPI 1619505765
  Medicare reassignment
• Southland Emergency Medical Services Consolidated, LLC

  • Hospitalist Physician
  • Cochran, GA
  • NPI 1033464391
  Medicare reassignment
• Hospital Authority of Washington County

  • Physical Therapy Clinic/Center
  • Sandersville, GA
  • NPI 1528619491
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Hospital Authority of Jefferson County and the City of Louisville

  dba Jefferson Hospital

  • General Acute Care Hospital
  • Louisville, GA
  • NPI 1710992433
  Care Compare affiliation

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

{
    "created_epoch": "1611532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634083200000",
    "number": "1841880655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 SULLIVAN LN",
            "city": "LA FAYETTE",
            "state": "GA",
            "postal_code": "307281500",
            "telephone_number": "423-298-5079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 SULLIVAN LN",
            "city": "LA FAYETTE",
            "state": "GA",
            "postal_code": "307281500",
            "telephone_number": "423-298-5079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKS",
        "first_name": "RANDY",
        "middle_name": "LEE",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-01-25",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "10641",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holli Guthrie, DPT
• Trameka Lashun Harris Jones, NURSE PRACTITIONER
• Healing Valley Wellness & Primary Care, LLC
• Eric Lee Helwig, O.D.
• Bethany Brooke Henderson
• Terrie Hix
• Adrienne Shaw Hubay
• Lora Hutcherson, PHARM.D
• Robert Hutcherson, PHARMD
• Sylvia Helen Hyde, FNP

• Physician Assistant in La Fayette, GA
• Providers in La Fayette, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.