Individual
DERRYL S. DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC, PTA
Contact information
Practice address
2850 JOHNSON FERRY RD STE 150, MARIETTA, GA 30062-8317
(770) 518-8786
Mailing address
1720 WINDCLIFF DR SE, MARIETTA, GA 30067-3801
(256) 225-0495
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
CHIR010363
GA
225200000X
Physical Therapy Assistant
PTA002699
GA
Other
Enumeration date
08/31/2010
Last updated
05/21/2020
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