Healthcare Provider Details

I. General information

NPI: 1508561911
Provider Name (Legal Business Name): MEGAN DICKERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 RICHLAND MEDICAL PARK DR
COLUMBIA SC
29203-6859
US

IV. Provider business mailing address

1735 CITY CENTER BLVD
ELIZABETH CITY NC
27909-3468
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-7606
  • Fax:
Mailing address:
  • Phone: 252-338-2155
  • Fax: 252-338-7704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLL89720
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: