Provider Demographics
NPI:1700366408
Name:HICKS, STEPHEN CHARLES (DO)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:CHARLES
Last Name:HICKS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3686 GRANDVIEW PARKWAY SUITE 820
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243
Mailing Address - Country:US
Mailing Address - Phone:205-971-3000
Mailing Address - Fax:205-971-4910
Practice Address - Street 1:3686 GRANDVIEW PARKWAY SUITE 820
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243
Practice Address - Country:US
Practice Address - Phone:205-971-3000
Practice Address - Fax:205-971-4910
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL.4796R390200000X
ALDO.2112207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program