Individual provider Active NPI

Taylor Brooke Dickerson, NP-C

  • Family Nurse Practitioner
  • Macon, GA
National Provider Identifier
1073180774
Registry record updated Oct 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN268334 Issued in GA
Practice address
5400 Riverside Dr Ste 202
Macon, GA 31210-0818
Phone
(478) 787-0059
NPI assigned
Jun 10, 2021
Last updated
Oct 9, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN268334 GA Primary

Addresses

Primary practice location

5400 Riverside Dr Ste 202
Macon, GA 31210-0818

Mailing address

3470 Osborne PL
Macon, GA 31204-1844
Phone (229) 322-5710

Other practice location 1

100 Tommy Stalnaker Dr Ste A
Warner Robins, GA 31088-1403
Phone (470) 787-0059

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220419001178 GA Practitioner - Nurse Practitioner 6709273972 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Avilys-Sleep and EegGroup PAC ID 7719303072, 10 clinicians

Practice addresses (Care Compare)

2300 Northside Xing
Suite B
Macon, GA 31210-2254
Phone (855) 228-4597

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN268334GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ga Diagnostic Providers LLC CurrentSince Jun 20, 2025 Accepting new patients

Locations

5400 Riverside Dr
Ste 101
Macon, GA 31210

5400 Riverside Dr
Ste 202
Macon, GA 31210
Phone (478) 787-0059

100 Tommy Stalnaker Dr
Ste A
Warner Robins, GA 31088
Phone (478) 333-2087

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759968000000",
    "number": "1073180774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3470 OSBORNE PL",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312041844",
            "telephone_number": "229-322-5710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5400 RIVERSIDE DR STE 202",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312100818",
            "telephone_number": "478-787-0059"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Tommy Stalnaker Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Warner Robins",
            "state": "GA",
            "postal_code": "310881403",
            "country_code": "US",
            "telephone_number": "470-787-0059",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "TAYLOR",
        "middle_name": "BROOKE",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-10",
        "last_updated": "2025-10-09",
        "certification_date": "2025-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN268334",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Macon, GA

Sources for this page

Verify at the official NPI Registry.