Provider Demographics
NPI:1427929744
Name:DICKERSON, DAJEUN LAMAR SR
Entity type:Individual
Prefix:MR
First Name:DAJEUN
Middle Name:LAMAR
Last Name:DICKERSON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 9TH ST SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44706-5187
Mailing Address - Country:US
Mailing Address - Phone:330-412-3438
Mailing Address - Fax:
Practice Address - Street 1:1514 9TH ST SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44706-5187
Practice Address - Country:US
Practice Address - Phone:330-412-3438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-17
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0494856251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health