Provider Demographics
NPI:1063944452
Name:HICKS, ROBYN M (CFA)
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:M
Last Name:HICKS
Suffix:
Gender:F
Credentials:CFA
Other - Prefix:
Other - First Name:ROBYN
Other - Middle Name:M
Other - Last Name:SMALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:114 ROSEBERRY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PORT WENTWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:31407
Mailing Address - Country:US
Mailing Address - Phone:912-688-4155
Mailing Address - Fax:912-839-5591
Practice Address - Street 1:5353 REYNOLDS STREET
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405
Practice Address - Country:US
Practice Address - Phone:912-869-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172671246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant