Provider Demographics
NPI:1306889068
Name:HICKS, JULIE PALBYKIN (MD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:PALBYKIN
Last Name:HICKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:K
Other - Last Name:PALBYKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1705
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-1705
Mailing Address - Country:US
Mailing Address - Phone:706-774-7263
Mailing Address - Fax:706-774-7230
Practice Address - Street 1:447 N BELAIR RD STE 101
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3091
Practice Address - Country:US
Practice Address - Phone:706-854-2222
Practice Address - Fax:706-854-2223
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047221207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00255610OtherRAILROAD MEDICARE
SCL27905Medicaid
GA000467519AMedicaid
GA511I080491Medicare PIN
SCL27905Medicaid
GA000467519AMedicaid
TNP00255610OtherRAILROAD MEDICARE
GAH37060Medicare UPIN