Provider Demographics
NPI:1861064644
Name:HICKS, EDWARD DICKSON VI (APC)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:DICKSON
Last Name:HICKS
Suffix:VI
Gender:M
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 ATLANTA RD SE STE 120
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6521
Mailing Address - Country:US
Mailing Address - Phone:770-858-5377
Mailing Address - Fax:
Practice Address - Street 1:4125 ATLANTA RD SE STE 120
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6521
Practice Address - Country:US
Practice Address - Phone:770-858-5377
Practice Address - Fax:770-800-8164
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC006341101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health