Most Relevant Information
Provider Data
| NPI Number: | 1003203431 |
| Provider Name: | ELLEN MYREE HICKS ATC |
| Entity Type: | Individual |
| Taxonomy Code: | 2255A2300X |
| Specialty: | Specialist/Technologist |
| License Number: | 0126000363 |
Most Important Dates
| Enumeration Date: | 04/23/2015 |
| Last Updated: | 04/23/2015 |
Provider Practice Location
5939 FLANK CIR
PORT REPUBLIC
VA
244712231
Practice Location Phone/Fax
| Phone: | 5408285368 |
| Fax: | 5405153763 |
Provider Mailing Location
5939 FLANK CIR
PORT REPUBLIC
VA
244712231
Provider Mailing Phone/Fax
| Phone: | 5408285368 |
| Fax: | 5405153763 |