Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN014642 | GA |
N | 204E00000X | Oral & Maxillofacial Surgeon | 2019013206 | MO |
NPI | 1194168328 |
---|---|
Provider Name | Dr. Raymond Charles Dickey JR. |
First Address | Roberta, GA 31078-6834 |
Second Address | Atlanta, GA 30331-5599 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2013 |
Last Update Date | 25/03/2021 |