Provider Demographics
NPI:1376513523
Name:DICKSON, LORETTA ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:LORETTA
Middle Name:ANNE
Last Name:DICKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-650-4413
Practice Address - Street 1:281 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-3126
Practice Address - Country:US
Practice Address - Phone:828-245-6400
Practice Address - Fax:828-245-3838
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2000-00771207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCA0095OtherMEDCOST
SCP01445421OtherRAILROAD MEDICARE
NC8912627Medicaid
NCG90207Medicare UPIN
NC2280942Medicare PIN
SCA0095OtherMEDCOST