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General NPI Number Information
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NPI Number | 1760462311
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Entity Type | Individual
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Provider Name | JENNIFER C DICKENS MD
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Gender | Female
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 07/03/2008
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Provider Practice Location Address
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Address Line | 113 MILLWOOD DR
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City | FORT MILL
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State | SC
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Zip | 29715-8356
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Country | US
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Telephone | 803-802-9488
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Fax |
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Provider Business Mailing Address
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Address Line | 113 MILLWOOD DR
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City | FORT MILL
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State | SC
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Zip | 29715-8356
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Country | US
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Telephone | 803-802-9488
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD 26669
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2001-01321
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License Number State | NC
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