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Individual

JOHN GRAHAM DICKERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1800 DRAYTON RD STE 313, DRAYTON, SC 29333-7002
(864) 415-1540
Mailing address
1800 DRAYTON RD STE 313, DRAYTON, SC 29333-7002
(864) 415-1540

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20810
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
208108
SC
01
P00386791
MEDICARE RAILROAD PTAN
GA
Enumeration date
05/18/2006
Last updated
09/21/2020
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