Dickerson, Jill B

Dickerson, Jill B is an sole proprietor health care provider with primary practice located at 10 Market Square Way Ste 100 , Newnan GA 30265-6078. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Dickerson, Jill B can be contacted via phone (678) 423-5560.

Contact Information

Primary practice address
10 Market Square Way Ste 100 Newnan GA 30265-6078
Fax: (678) 423-5563
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 061061 Georgia

Profile Details

NPI number 1497714257
LBN Legal business name Dickerson, Jill B
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 21st, 2006
Last updated Oct 22nd, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1497714257 NPPES
Georgia MEDICAID 182611684A

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