Healthcare Provider Details

I. General information

NPI: 1265286801
Provider Name (Legal Business Name): EMILY ELIZABETH DICKINSON PA-C, CHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 CHURCH ST N STE 255
CONCORD NC
28025-2927
US

IV. Provider business mailing address

497 MEADOWLARK CIR SE
CONCORD NC
28025-6019
US

V. Phone/Fax

Practice location:
  • Phone: 704-403-1331
  • Fax:
Mailing address:
  • Phone: 217-722-6078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: