Provider Demographics
NPI:1467011148
Name:HICKS, GEORGE LEMAR III (ATC)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:LEMAR
Last Name:HICKS
Suffix:III
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4360 SETTLEMENT WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80925-9597
Mailing Address - Country:US
Mailing Address - Phone:260-636-0847
Mailing Address - Fax:
Practice Address - Street 1:4360 SETTLEMENT WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80925-9597
Practice Address - Country:US
Practice Address - Phone:260-636-0847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.0001695207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine