Provider Demographics
NPI:1790174977
Name:DICKERSON, SHEILA (LPN)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:
Other - Last Name:BRANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:302 TIMBERLINE DR
Mailing Address - Street 2:
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30535-4856
Mailing Address - Country:US
Mailing Address - Phone:706-949-1723
Mailing Address - Fax:706-778-0315
Practice Address - Street 1:302 TIMBERLINE DR
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535-4856
Practice Address - Country:US
Practice Address - Phone:706-949-1723
Practice Address - Fax:706-778-0315
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040602164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse