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NPI Code Detail

MEDICARE: DR. KRISTIN MICHELLE DICKSON MD

MEDICARE: DR. KRISTIN MICHELLE DICKSON MD
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
12084P0800XPsychiatry Physician056845GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1056845OTHERGAGEORGIA LICENSE

General Provider Information

NPI Number : 1760445225
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRISTIN MICHELLE DICKSON MD
Provider Business Mailing Address
First Line : 966 DREWRY ST NE
Second Line :
City : ATLANTA
State : GA
Zip : 30306-3800
Country : US
Telephone Number : 678-923-8021
Fax Number :
Provider Business Practice Location Address
First Line : 650 PONCE DE LEON AVE NE STE 300
Second Line :
City : ATLANTA
State : GA
Zip : 30308-1864
Country : US
Telephone Number : 678-250-8021
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2006
Last Update Date : 06/02/2022

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