1. Home
  2. Directory
  3. Georgia
  4. Mableton
  5. Otolaryngology
  6. NPI Profile

MRS. SANDRA JONES DICKERSON M.D.
NPI 1164521985
Otolaryngology in Mableton, GA

Active since September 21, 2006PECOS Enrolled
5695 KILRUSH CT SE, MABLETON, GA 30126(404) 578-1057 Get Directions Write a Review

NPPES record last updated: April 21, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Apr 21, 2021, Jun 11, 2019 (2 updates tracked since 2019).

About Mrs. Sandra Jones Dickerson M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. SANDRA JONES DICKERSON M.D. (NPI 1164521985) is an individual otolaryngology provider in Mableton, Georgia, licensed in Georgia (34869) and active in the NPI registry since September 2006. She is enrolled in Medicare PECOS and maintains a secondary practice location in Vidalia.

NPPES Registry Identity

NPI1164521985
Entity TypeIndividualFemale
Primary Taxonomy207Y00000X
Provider Legal NameMRS. SANDRA JONES DICKERSONCredential: M.D.
Location Address5695 KILRUSH CT SEMableton, GA 30126-5636
Mailing Address5695 Kilrush Ct SeMableton, GA 30126-5636 · (404) 578-1057
Phone(404) 578-1057
Sole ProprietorNo
Enumeration DateSeptember 21, 2006
Last NPPES UpdateApril 21, 20212 updates tracked since enumeration
NPPES CertifiedApril 21, 2021
✔ NPI 1164521985 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOtolaryngologyAllopathic & Osteopathic Physicians
Taxonomy Code207Y00000X
License✔ Licensed in GA · 34869
Definition
An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise.
5695 KILRUSH CT SE, Mableton, GA 30126
Open in Google Maps ↗

Secondary Practice Location 1

Location 11707 Meadows Ln Ste CVidalia, GA 30474-7201 · Phone (912) 537-3384 · Fax (912) 537-3351

Other Identifiers 2

Medicaid000469675AGA
Other58-1158044GA · Tax Id

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mrs. Sandra Jones Dickerson M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Sandra Dickerson reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

The Southeast Permanente Medical Group
8.7 mi
Internal Medicine
3495 PIEDMONT ROAD NE, NINE PIEDMONT CENTER
Atlanta, GA 30305
  • Reassigned Medicare billing, Georgia enrollment
  • 1,389 clinicians in this Medicare group
NPI 1245266956 (404) 364-3821
Upson Surgical Associates, LLC
65 mi
Surgery
612 WEST GORDON STREET, SUITE E
Thomaston, GA 30286
  • Reassigned Medicare billing, Georgia enrollment
  • 36 clinicians in this Medicare group
NPI 1790076974 (706) 647-3116

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30126 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$130.64 typical visit price
range $56.84 – $172.43
Typical copayment $32.66 (range $14.21 – $43.10)
Most-billed visit code 99204
Established Patient
$70.85 typical visit price
range $18.22 – $140.40
Typical copayment $17.71 (range $4.55 – $35.10)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Sandra Dickerson's NPI number?

The NPI number for Sandra Dickerson is 1164521985. It was assigned to this individual provider in the NPPES registry on September 21, 2006.

Where is Sandra Dickerson located?

Sandra Dickerson practices at 5695 Kilrush Ct SE, Mableton, GA 30126. The listed phone number is (404) 578-1057.

What is Sandra Dickerson's specialty?

The primary specialty registered for this NPI is Otolaryngology with taxonomy code 207Y00000X.

Is Sandra Dickerson enrolled in Medicare?

Yes. Sandra Dickerson is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Sandra Dickerson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Sandra Dickerson reassigns Medicare benefits to 2 organizations: The Southeast Permanente Medical Group (Atlanta, GA) and Upson Surgical Associates, LLC (Thomaston, GA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Sandra Dickerson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Sandra Dickerson was last updated on April 21, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.