| NPI | 1184973109 |
|---|---|
| Former Name | JOHNNA RENEE HICKS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 81571) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 78307) |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2019-11-13 |