MEDICARE: MILTON LOUIS DICKERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver	045131076	TN

General Provider Information

NPI Number	:	1255651139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILTON LOUIS DICKERSON

Provider Business Mailing Address
First Line	:	3350 MILLINGTON RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38127-5216
Country	:	US
Telephone Number	:	901-353-1353
Fax Number	:	901-353-6412

Provider Business Practice Location Address
First Line	:	3350 MILLINGTON RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38127-5216
Country	:	US
Telephone Number	:	901-353-1353
Fax Number	:	901-353-6412

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2010
Last Update Date	:	06/02/2010

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Directions to “ MILTON LOUIS DICKERSON ” Practice Location

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