MEDICARE: CHARLOTTE DICKERSON

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
1	363LF0000X	Family Nurse Practitioner	RN315361	GA

General Provider Information

NPI Number	:	1962333708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTE DICKERSON

Provider Business Mailing Address
First Line	:	22 E 64TH ST
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31405-5202
Country	:	US
Telephone Number	:	847-767-0134
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 E 64TH ST
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31405-5202
Country	:	US
Telephone Number	:	847-767-0134
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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Directions to “ CHARLOTTE DICKERSON ” Practice Location

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