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Organization
RIVERDALE FOOT, ANKLE AND LEG CLINIC
Active
Organization
RIVERDALE FOOT, ANKLE AND LEG CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERRY LEE DICKERSON DPM (PRESIDENT/CEO)
(770) 997-3668
Entity
Organization
Contact information
Practice address
6567 PROFESSIONAL PL, RIVERDALE, GA 30274-2519
(770) 997-3668
(770) 997-3470
Mailing address
6567 PROFESSIONAL PL, RIVERDALE, GA 30274-2519
(770) 997-3668
(770) 997-3470
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
000890
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00869679E
—
GA
01
—
52811908
BLUE CROSS BLUE SHIELD
GA
01
—
7302184
AETNA
GA
Enumeration date
12/15/2007
Last updated
07/03/2026
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