Healthcare Provider Details

I. General information

NPI: 1609041292
Provider Name (Legal Business Name): ERIN JOHNSTON DICKERT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN JOANNA JOHNSTON

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 HALTON RD
GREENVILLE SC
29607-3405
US

IV. Provider business mailing address

PO BOX 26536
GREENVILLE SC
29616-1536
US

V. Phone/Fax

Practice location:
  • Phone: 864-331-3230
  • Fax: 864-331-3236
Mailing address:
  • Phone: 864-331-3230
  • Fax: 864-331-3236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberR1431
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number35489
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: