Provider Demographics
NPI:1871155366
Name:HICKMON, RONNIE EUGENE
Entity type:Individual
Prefix:
First Name:RONNIE
Middle Name:EUGENE
Last Name:HICKMON
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 1:3528 ONEONTA AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3391
Mailing Address - Country:US
Mailing Address - Phone:919-539-4099
Mailing Address - Fax:919-336-1120
Practice Address - Street 1:3528 ONEONTA AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3391
Practice Address - Country:US
Practice Address - Phone:919-539-4099
Practice Address - Fax:919-336-1120
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)