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NPI Code Detail

MEDICARE: DR. JAMIE DICKSON PSY.D.

MEDICARE:  DR. JAMIE  DICKSON  PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPSY003318GA

General Provider Information

NPI Number : 1518219963
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMIE DICKSON PSY.D.
Provider Business Mailing Address
First Line : 5259 VERNON SPRINGS TRL NW
Second Line :
City : ATLANTA
State : GA
Zip : 30327-4511
Country : US
Telephone Number : 404-276-1575
Fax Number :
Provider Business Practice Location Address
First Line : 5259 VERNON SPRINGS TRL NW
Second Line :
City : ATLANTA
State : GA
Zip : 30327-4511
Country : US
Telephone Number : 404-276-1575
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2012
Last Update Date : 10/10/2012

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