Healthcare Provider Details

I. General information

NPI: 1659557833
Provider Name (Legal Business Name): ANDREW GARRETT DICKERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MEDICAL CENTER BLVD
LAWRENCEVILLE GA
30046-7694
US

IV. Provider business mailing address

PO BOX 930223
ATLANTA GA
31193-0223
US

V. Phone/Fax

Practice location:
  • Phone: 678-312-3294
  • Fax: 678-312-3282
Mailing address:
  • Phone: 470-325-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number002183
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number63315
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: