Provider Demographics
NPI:1578250957
Name:DICKERSON, AMY HARGRAVE (RDN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:HARGRAVE
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9085 DAHLGREN RD
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-3506
Mailing Address - Country:US
Mailing Address - Phone:804-874-2575
Mailing Address - Fax:
Practice Address - Street 1:9085 DAHLGREN RD
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-3506
Practice Address - Country:US
Practice Address - Phone:804-874-2575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered