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General NPI Number Information
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NPI Number | 1891675849
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Entity Type | Individual
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Provider Name | CONSUELA DICKERSON-WHITFIELD
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Gender | Female
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Dates
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Enumeration Date | 09/02/2025
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 5385 FIVE FORKS TRICKUM RD STE N
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-3018
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Country | US
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Telephone | 470-610-9299
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Fax |
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Provider Business Mailing Address
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Address Line | 5385 FIVE FORKS TRICKUM RD STE N
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-3018
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Country | US
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Telephone | 470-610-9299
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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 | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 2993387
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License Number State | GA
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