Individual provider · NPI-1

Derryl S. Dickerson, DC, PTA

Chiropractor, Rehabilitation · Marietta, GA

NPI number1316253107
StatusActive
Last updated in NPPESMay 21, 2020

Details

NPI
1316253107
Entity type
Individual (NPI-1)
Name
Derryl S. Dickerson
Credential
DC, PTA
Sex
Male
Sole proprietor
No
Enumeration date
Aug 31, 2010
Certification date
May 21, 2020
Last updated
May 21, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
111NR0400X Chiropractor, RehabilitationCHIR010363GAYes
225200000X Physical Therapy AssistantPTA002699GA

Practice location

2850 Johnson Ferry Rd Ste 150
Marietta, GA 30062-8317

Phone 770-518-8786

Mailing address

1720 Windcliff Dr Se
Marietta, GA 30067-3801

Phone 256-225-0495

Other practice locations

3890 Redwine Rd Sw
Suite 114
Atlanta, GA 30331-5582

Phone 404-344-7880 · Fax 404-344-7881

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