Provider Demographics
NPI:1952392201
Name:DICKSON, PAUL L (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:L
Last Name:DICKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 SPRINGBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CORNELIA
Mailing Address - State:GA
Mailing Address - Zip Code:30531-5090
Mailing Address - Country:US
Mailing Address - Phone:770-654-0380
Mailing Address - Fax:
Practice Address - Street 1:123 SPRINGBROOK DR
Practice Address - Street 2:
Practice Address - City:CORNELIA
Practice Address - State:GA
Practice Address - Zip Code:30531-5090
Practice Address - Country:US
Practice Address - Phone:770-654-0380
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025963208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery