Provider Demographics
NPI:1104808328
Name:HICKS, AMY GAMMILL (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:GAMMILL
Last Name:HICKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1436 EAGLE MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-4057
Mailing Address - Country:US
Mailing Address - Phone:210-265-9862
Mailing Address - Fax:
Practice Address - Street 1:2510 5TH ST
Practice Address - Street 2:USAFSAM/FECI
Practice Address - City:WRIGHT PATTERSON AFB
Practice Address - State:OH
Practice Address - Zip Code:45433
Practice Address - Country:US
Practice Address - Phone:937-938-2755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01060713A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine