Individual
QUINTON HOWARD DICKERSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
970 LAKELAND DR, SUITE 61, JACKSON, MS 39216-4635
(601) 982-7850
(601) 718-5145
Mailing address
970 LAKELAND DR, SUITE 61, JACKSON, MS 39216-4635
(601) 982-7850
(601) 718-5145
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
5261
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00014082
—
MS
Enumeration date
06/13/2006
Last updated
02/02/2010
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