Individual
MRS. SANDRA JONES DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5695 KILRUSH CT SE, MABLETON, GA 30126-5636
(404) 578-1057
Mailing address
5695 KILRUSH CT SE, MABLETON, GA 30126-5636
(404) 578-1057
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
34869
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000469675A
—
GA
01
—
58-1158044
TAX ID
GA
Enumeration date
09/21/2006
Last updated
04/21/2021
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