Provider Demographics
NPI:1104802388
Name:HICKS, JOHN TRIMMER (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:TRIMMER
Last Name:HICKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29648-0427
Mailing Address - Country:US
Mailing Address - Phone:864-953-8002
Mailing Address - Fax:864-953-9690
Practice Address - Street 1:917 BYPASS 225 S
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-8025
Practice Address - Country:US
Practice Address - Phone:864-953-8002
Practice Address - Fax:864-953-9690
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15159207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC571122060OtherBLUE CROSS/BLUE SHIELD
SCGP3287Medicaid
SCGP3287Medicaid
SCD05839Medicare UPIN