Sandra Jones Dickerson, M.D.

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

34869 Issued in GA

Practice address

5695 Kilrush CT SE
Mableton, GA 30126-5636

Phone

(404) 578-1057

NPI assigned

Sep 21, 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 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sandra.dickerson@srpcc.gadirect.net

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

• The Southeast Permanente Medical Group

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1245266956

  Otolaryngology

  Medicare reassignment NPD
• Upson Surgical Associates, LLC

  • Surgery Physician
  • Thomaston, GA
  • NPI 1790076974
  Medicare reassignment NPD
• Southeast Regional Primary Care Corporation

  • Multi-Specialty Clinic/Center
  • Vidalia, GA
  • NPI 1467568907
  NPD

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618963200000",
    "number": "1164521985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5695 KILRUSH CT SE",
            "city": "MABLETON",
            "state": "GA",
            "postal_code": "301265636",
            "telephone_number": "404-578-1057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5695 KILRUSH CT SE",
            "city": "MABLETON",
            "state": "GA",
            "postal_code": "301265636",
            "telephone_number": "404-578-1057"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1707 Meadows Ln Ste C",
            "address_purpose": "LOCATION",
            "city": "Vidalia",
            "state": "GA",
            "postal_code": "304747201",
            "country_code": "US",
            "telephone_number": "912-537-3384",
            "fax_number": "912-537-3351",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "SANDRA",
        "middle_name": "JONES",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-21",
        "last_updated": "2021-04-21",
        "certification_date": "2021-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "GA",
            "license": "34869",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000469675A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX  ID",
            "identifier": "58-1158044",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pamela Annette Daniel
• Charles L Davenport Jr.
• David J Pasquariello DC PC
• Gekiya Davis
• Michele a. De la Cruz, MHS, MPP,PHD
• Robert Keith Dickinson, PHARM.D.
• Nicole Dillard, LMT
• Morton Blair Dimenstien, DMD
• Discover Speech LLC
• Kadeeja Douglas

• Otolaryngology Physician in Mableton, GA
• Providers in Mableton, GA by specialty
• Otolaryngology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.