Alissa Rodgers Dickerson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

A982 Issued in SC

Practice address

21 Gamecock Ave Ste E
Charleston, SC 29407-3368

Phone

(843) 763-9664

Fax

(843) 763-2949

NPI assigned

Jun 29, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104854181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "779 CONDON DR",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294124703",
            "telephone_number": "843-795-6366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 GAMECOCK AVE STE E",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294073368",
            "telephone_number": "843-763-9664",
            "fax_number": "843-763-2949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "ALISSA",
        "middle_name": "RODGERS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "A982",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0337PA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dee Ellen Dibona, MD
• Sydney Dibona
• Julia Kristina Dibos, BCBA
• Linda A. Dicamillo, AUD, CCC-A
• Tara Dicker, PHARMD
• James William Dickert Jr., DMD
• Dane Richard Dickey, MD
• Elizabeth C Dickinson, ACNP
• Lauren Elizabeth Dickman, DMD
• Amy Hull Dickson, MHA, MS, CCC-SLP

• Physician Assistant in Charleston, SC
• Providers in Charleston, SC by specialty
• Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.