Provider Demographics
NPI:1760445225
Name:DICKSON, KRISTIN MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:MICHELLE
Last Name:DICKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:DICKSON
Other - Last Name:SHEEHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:966 DREWRY ST NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-3800
Mailing Address - Country:US
Mailing Address - Phone:678-923-8021
Mailing Address - Fax:
Practice Address - Street 1:650 PONCE DE LEON AVE NE STE 300
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1864
Practice Address - Country:US
Practice Address - Phone:678-250-8021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0568452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA056845OtherGEORGIA LICENSE