Healthcare Provider Details

I. General information

NPI: 1639963028
Provider Name (Legal Business Name): AIMEE E DICKSON MSN, APRN, FNP-C
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1498 JESSE JEWELL PKWY SE STE C
GAINESVILLE GA
30501-3874
US

IV. Provider business mailing address

130 RIVERSTONE TER STE 102
CANTON GA
30114-1702
US

V. Phone/Fax

Practice location:
  • Phone: 770-744-4806
  • Fax:
Mailing address:
  • Phone: 470-863-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF02250768
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN289764
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: