HOLLY HICKS-DERIDDER (NPI# 1578641627) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578641627 |
| Entity Type | Individual |
| Full Name | HOLLY HICKS-DERIDDER |
| Credential | PA-C |
| Practice Address |
2700 Highway 34 E Bldg 300 Newnan GA 30265-1330 |
| Practice Telephone | 7703040987 |
| Practice Fax Number | 7702510938 |
| Mailing Telephone | 7703040987 |
| Mailing Fax Number | 7702510938 |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2011-11-01 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
003338 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 100002196A | 05 |
| Street Address |
2700 HIGHWAY 34 E BLDG 300 |
| City | NEWNAN |
| State | GA |
| Zip Code | 30265-1330 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295925402 | Christopher A Stansell | Physician Assistant | 2700 Highway 34 E Bldg 300, Newnan, GA 30265-1330 | 2007-07-25 |
| 1750581112 | Premier Medical Group of Coweta 2llc | Clinic/Center | 2700 Highway 34 E Bldg 300, Newnan, GA 30265-1330 | 2007-07-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265041537 | Shiva Bazargan | Pharmacist | 3116 Sr 34 West, Newnan, GA 30265 | 2020-07-23 |
| 1992322549 | Doctorsbeyond Inc. | Clinic/Center | 277 Skyview Court, Newnan, GA 30265 | 2020-06-30 |
| 1225652936 | Jerrica Conyers | Nurse Practitioner | 1635 Highwat 34 East Suite C, Newnan, GA 30265 | 2020-05-29 |
| 1982234688 | Morgan Elizabeth Bross | Physician Assistant | 1825 Ga- 34, Newnan, GA 30265 | 2020-01-22 |
| 1013553379 | Hopebridge LLC | Behavior Technician | 2147 Newnan Crossing Boulevard East, Newnan, GA 30265 | 2019-11-21 |
| 1518528116 | Stepping Stones Psychiatric Care LLC | Nurse Practitioner | 3025 Sharpsburg Mccullum Rd, Building B Suite 103, Newnan, GA 30265 | 2019-06-25 |
| 1356823363 | Stephen William Jacon | Specialist/Technologist | 29 Muirfield Court, Newnan, GA 30265 | 2018-09-05 |
| 1881176832 | Blueprint Psychiatry, LLC | Psychiatry & Neurology | 1601 Highway 34 E Ste A, Newnan, GA 30265 | 2018-09-05 |
| 1548790769 | Timothy Collins | Physical Therapist | 1755 Ga-34, Suite 1300, Rehab Department, Newnan, GA 30265 | 2017-06-20 |
| 1497289748 | Edible Health & Wellness,llc | Clinic/Center | 90f Glenda Trace Pmb 318, Newnan, GA 30265 | 2017-04-13 |
| Find all providers in zip 30265 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316357213 | Ben Summer | Physician Assistant | 1825 Georgia 34 #1300, Newnan, GA 30265 | 2014-04-30 |
| 1003192436 | Lauren A Jernigan | Physician Assistant | 10 Market Square Way, Suite 100, Newnan, GA 30265 | 2011-10-31 |
| 1598846719 | Garrett D Freeman | Physician Assistant | 2045 Highway 34 E, Newnan, GA 30265-1327 | 2006-10-17 |
| 1437107364 | Felicia R Slaton | Physician Assistant | 600 Parkway N, Newnan, GA 30265-8000 | 2006-05-04 |
| 1437117280 | Karen Scharett Secor | Physician Assistant | 39 Oak Hill Ct Bldg C, Newnan, GA 30265-2392 | 2006-05-02 |
| 1629632807 | Kathleen Ann Keirn | Physician Assistant | 745 Poplar Rd, Newnan, GA 30265-1618 | 2019-04-23 |
| 1437518859 | Carl A Frizell | Physician Assistant | 600 Celebrate Life Pkwy, Newnan, GA 30265-8001 | 2016-02-12 |
| 1992125769 | Alexandra Victoria Camp | Physician Assistant | 1825 Highway 34 E, Suite 1200, Newnan, GA 30265-6423 | 2014-04-21 |
| 1093077117 | Sarah Riordan Bence | Physician Assistant | 1825 Highway 34 E, Newnan, GA 30265-6423 | 2012-06-14 |
| 1245556588 | Coweta Emergency Group LLC | Physician Assistant | 60 Hospital Rd, Newnan, GA 30263-1210 | 2010-04-12 |
| Find all providers in NEWNAN | ||||
Please comment or provide details below to improve the information on HOLLY HICKS-DERIDDER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.