Mrs Sandra Jones Dickerson, MD in Mableton, GA

Mrs Sandra Jones Dickerson, MD is a medicare enrolled "Otolaryngology" physician in Mableton, Georgia. Her current practice location is 5695 Kilrush Ct Se, Mableton, Georgia. You can reach out to her office (for appointments etc.) via phone at (404) 578-1057.

Mrs Sandra Jones Dickerson is licensed to practice in Georgia (license number 34869) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1164521985.

Contact Information

	Mrs Sandra Jones Dickerson, MD
	5695 Kilrush Ct Se, Mableton, GA 30126-5636
	(404) 578-1057
	Not Available

Map and Direction

Physician's Profile

Full Name	Mrs Sandra Jones Dickerson
Gender	Female
Speciality	Otolaryngology
Location	5695 Kilrush Ct Se, Mableton, Georgia
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1164521985
Provider Enumeration Date: 09/21/2006
Last Update Date: 04/21/2021

Medicare PECOS Information:

PECOS PAC ID: 4183813561
Enrollment ID: I20110118000033

Medical Identifiers

Medical identifiers for Mrs Sandra Jones Dickerson such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1164521985	NPI	-	NPPES
000469675A	Medicaid	GA
58-1158044	Other	GA	TAX ID

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
207Y00000X	Otolaryngology	34869 (Georgia)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mrs Sandra Jones Dickerson allows following entities to bill medicare on her behalf.

Entity Name	The Southeast Permanente Medical Group
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1245266956 PECOS PAC ID: 6204829013 Enrollment ID: O20040407000370

Entity Name	Upson Surgical Associates, Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1790076974 PECOS PAC ID: 2062690480 Enrollment ID: O20110706000402

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Sandra Jones Dickerson is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Mrs Sandra Jones Dickerson, MD 5695 Kilrush Ct Se, Mableton, GA 30126-5636 Ph: (404) 578-1057	Mrs Sandra Jones Dickerson, MD 5695 Kilrush Ct Se, Mableton, GA 30126-5636 Ph: (404) 578-1057

Mrs Sandra Jones Dickerson, MD - Medicare Otolaryngology in Mableton, GA