Provider Demographics
NPI:1043736507
Name:HICKS, DONALD
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:HICKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6677 STURGEON RD
Mailing Address - Street 2:
Mailing Address - City:DOLPHIN
Mailing Address - State:VA
Mailing Address - Zip Code:23843-2517
Mailing Address - Country:US
Mailing Address - Phone:804-691-8438
Mailing Address - Fax:
Practice Address - Street 1:6677 STURGEON RD
Practice Address - Street 2:
Practice Address - City:DOLPHIN
Practice Address - State:VA
Practice Address - Zip Code:23843-2517
Practice Address - Country:US
Practice Address - Phone:804-691-8438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver