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Contact Information

GREGG A DICKERSON, MD
1514 E UNION ST
GREENVILLE, MS38703-3248
 Phone: 662-332-6150
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Radiation Oncology

2085R0001X 92 Physician/Radiation Oncology
 

Specialist

174400000X
Indicates primary specialty

NPI Profile & details for GREGG A DICKERSON · (Male)

NPI Number 1699777854
Status Active
Credentials MD
Entity Individual
Enumeration date 06/01/2005
Last updated 11/30/2016 - About 10 years ago
Sole proprietor 1 Yes
Identifiers
  • CO License # 47586
  • MS License # 17812
  • MN Other 896610 USA MANAGED CARE ORG
  • MS Other 10781438 UNITEDHEALTHCARE CAQH
Hospital affiliation(s)
  • DELTA REGIONAL MEDICAL CENTER - (Acute Care)
    1400 E UNION ST
    GREENVILLE, MS 38704
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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