Individual
DR. TERRY DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
6567 PROFESSIONAL PL, RIVERDALE, GA 30274-2519
(770) 997-3668
Mailing address
6567 PROFESSIONAL PL, RIVERDALE, GA 30274-2519
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
—
202833600
DEPARTMENT OF LABOR
GA
01
—
52811908
BLUE CROSS BLUE SHIELD
GA
01
—
7302184
AETNA
GA
Enumeration date
08/02/2005
Last updated
11/20/2008
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