Provider Demographics
NPI:1174594477
Name:KLICKMAN, HOWARD W (MD)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:W
Last Name:KLICKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:139 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340
Practice Address - Country:US
Practice Address - Phone:864-487-7186
Practice Address - Fax:864-487-7246
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28209207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4111064OtherAETNA
SCAA1030J577OtherMEDICARE PIN
NC5902122Medicaid
SCE2006OtherMEDCOST
SC282090Medicaid
SCAA10309068OtherMEDICARE PIN
SC282090Medicaid
SCAA10309068Medicare PIN
SCE2006OtherMEDCOST
SC4111064OtherAETNA