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Individual

DR. JENNIFER C DICKENS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
113 MILLWOOD DR, FORT MILL, SC 29715-8356
(803) 802-9488
Mailing address
113 MILLWOOD DR, FORT MILL, SC 29715-8356
(803) 802-9488

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2001-01321
NC
207Q00000X
Family Medicine Physician
Primary
MD 26669
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
891360E
NC
Enumeration date
01/19/2006
Last updated
07/03/2008
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