Provider Demographics
NPI:1861792772
Name:HICKS, THOMAS HOLLIDAY (LPN)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:HOLLIDAY
Last Name:HICKS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 KEENAN ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-3106
Mailing Address - Country:US
Mailing Address - Phone:864-363-6858
Mailing Address - Fax:
Practice Address - Street 1:103 KEENAN ORCHARD DR
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-3106
Practice Address - Country:US
Practice Address - Phone:864-363-6858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPR31129164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse