Hicks-Deridder, Holly
Hicks-Deridder, Holly is an sole proprietor health care provider with primary practice located at 2700 Highway 34 E Bldg 300 , Newnan GA 30265-1330. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as her primary health care specialty. Hicks-Deridder, Holly can be contacted via phone (770) 304-0987.Contact Information
Primary practice address
2700 Highway 34 E Bldg 300
Newnan GA 30265-1330
Phone: (770) 304-0987
Fax: (770) 251-0938
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 003338 | Georgia |
Profile Details
| NPI number | 1578641627 |
|---|---|
| LBN Legal business name | Hicks-Deridder, Holly |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 2nd, 2006 |
| Last updated | Nov 1st, 2011 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1578641627 | NPPES |
| Georgia | MEDICAID | 100002196A |
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