Prestige Medical Clinic, LLC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

Legal business name

PRESTIGE MEDICAL CLINIC, LLC

Practice address

4529 Sterling Pointe Dr NW
Kennesaw, GA 30152-7321

Phone

(706) 333-9932

NPI assigned

Jan 26, 2021

Organization subpart

No

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

Authorized official

Name

Mrs. Christy Dickerson, AGNP-C

Title

Owner

Phone

(706) 333-9932

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1611619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611619200000",
    "number": "1881284511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1712",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301568712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4529 STERLING POINTE DR NW",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301527321",
            "telephone_number": "706-333-9932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTIGE MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-26",
        "last_updated": "2021-01-26",
        "certification_date": "2021-01-07",
        "status": "A",
        "authorized_official_last_name": "DICKERSON",
        "authorized_official_first_name": "CHRISTY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-333-9932",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "AGNP-C"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Health Nurse Practitioner in Kennesaw, GA
• Providers in Kennesaw, GA by specialty
• Adult Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 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.

Verify at the official NPI Registry.