Provider Demographics
NPI:1144947078
Name:DICKEY, KAY (CPC)
Entity type:Individual
Prefix:MS
First Name:KAY
Middle Name:
Last Name:DICKEY
Suffix:
Gender:F
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1166
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30086-1166
Mailing Address - Country:US
Mailing Address - Phone:770-609-6978
Mailing Address - Fax:
Practice Address - Street 1:5929 MUSKET LN
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-1710
Practice Address - Country:US
Practice Address - Phone:770-609-6978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332U00000X, 174200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals
No332U00000XSuppliersHome Delivered Meals