Provider Demographics
NPI:1578371886
Name:HICKS, JAMES LARRY
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LARRY
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 1:14036 GLENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-2882
Mailing Address - Country:US
Mailing Address - Phone:313-784-8389
Mailing Address - Fax:
Practice Address - Street 1:4000 TOWN CTR STE 1350
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-1427
Practice Address - Country:US
Practice Address - Phone:313-784-8389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker