Individual
DR. JILL B DICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
10 MARKET SQUARE WAY STE 100, NEWNAN, GA 30265-6078
(678) 423-5560
(678) 423-5563
Mailing address
87 TAPESTRY LN, NEWNAN, GA 30265-5649
(678) 423-5560
(678) 423-5563
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
061061
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182611684A
—
GA
Enumeration date
03/21/2006
Last updated
10/22/2012
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