Dickerson, Terry

Dickerson, Terry is an individual health care provider with primary practice located at 6567 Professional Pl , Riverdale GA 30274-2519. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, which is considered as his primary health care specialty. Dickerson, Terry can be contacted via phone (770) 997-3668.

Contact Information

Primary practice address
6567 Professional Pl Riverdale GA 30274-2519
Phone: (770) 997-3668
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X 000890 Georgia

Profile Details

NPI number 1598766313
LBN Legal business name Dickerson, Terry
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 2nd, 2005
Last updated Nov 20th, 2008 - about 16 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598766313 NPPES
Georgia MEDICAID 00869679E
Georgia Other 202833600
Georgia Other 7302184
Georgia Other 52811908

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