Active NPI
Misty Lowery Dickerson, PHARMD
- Pharmacist
- Gainesville, GA
National Provider Identifier
1063005270
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH023724
- Practice address
- 1439 Jesse Jewell Pkwy NE Ste 101
Gainesville, GA 30501-3806 - Phone
- (770) 219-6337
- Fax
- (770) 219-6338
- NPI assigned
- Feb 18, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH023724 | GA | Primary |
Addresses
Primary practice location
1439 Jesse Jewell Pkwy NE Ste 101
Gainesville, GA 30501-3806
Mailing address
1439 Jesse Jewell Pkwy NE Ste 101
Gainesville, GA 30501-3806
Phone (770) 219-6337
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RPH023724 | Other | GA | GEORGIA STATE BOARD OF PHARMACY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH023724 | GA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1613606400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613606400000",
"number": "1063005270",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1439 JESSE JEWELL PKWY NE STE 101",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "305013806",
"telephone_number": "770-219-6337",
"fax_number": "770-219-6338"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1439 JESSE JEWELL PKWY NE STE 101",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "305013806",
"telephone_number": "770-219-6337",
"fax_number": "770-219-6338"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKERSON",
"first_name": "MISTY",
"middle_name": "LOWERY",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-02-18",
"last_updated": "2021-02-18",
"certification_date": "2021-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH023724",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GEORGIA STATE BOARD OF PHARMACY",
"identifier": "RPH023724",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.