Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 4990 | AL |
Y | 213EG0000X | General Practice | 4990 | AL |
NPI | 1003900523 |
---|---|
Provider Name | Dr. Jennifer Talbert Dickson |
First Address | Tuscaloosa, AL 35406 |
Second Address | Tuscaloosa, AL 35406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
515-22638 | (02) | AL |