Provider Demographics
NPI:1851521140
Name:DICKERSON, RAYMOND SCOTT (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:SCOTT
Last Name:DICKERSON
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3333 RIVERWOOD PKWY SE STE 250
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3304
Mailing Address - Country:US
Mailing Address - Phone:770-914-0116
Mailing Address - Fax:770-955-4278
Practice Address - Street 1:2200 HIGHWAY 155 N
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252
Practice Address - Country:US
Practice Address - Phone:678-490-0341
Practice Address - Fax:678-490-0349
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2022-06-07
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Provider Licenses
StateLicense IDTaxonomies
GA004069363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant