Provider Demographics
NPI:1104921899
Name:HICKS, LILLIE SPEARS (RD)
Entity type:Individual
Prefix:MRS
First Name:LILLIE
Middle Name:SPEARS
Last Name:HICKS
Suffix:
Gender:F
Credentials:RD
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 468
Mailing Address - Street 2:3730 UNION CHURCH RD
Mailing Address - City:TUSKEGEE INSTITUTE
Mailing Address - State:AL
Mailing Address - Zip Code:36087
Mailing Address - Country:US
Mailing Address - Phone:334-727-0550
Mailing Address - Fax:
Practice Address - Street 1:2400 HOSPITAL RD
Practice Address - Street 2:VA HOSPITAL
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083
Practice Address - Country:US
Practice Address - Phone:334-727-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered