Basic Information
| Provider Information | |||||||||
| NPI: | 1932218039 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HICKEY | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3495 PIEDMONT RD NE | ||||||||
| Address2: | NINE PIEDMONT CENTER | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043647000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 CRESCENT CENTRE PARK | ||||||||
| Address2: | INTERNAL MEDICINE HEALTH CARE TEAM A | ||||||||
| City: | TUCKER | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704963625 | ||||||||
| FaxNumber: | 7704963717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 002036 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.