Healthcare Provider Details

I. General information

NPI: 1710618772
Provider Name (Legal Business Name): ALYSSA DICKERSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

854 W JAMES M CAMPBELL BLVD STE 403
COLUMBIA TN
38401-4659
US

IV. Provider business mailing address

854 W JAMES M CAMPBELL BLVD STE 303
COLUMBIA TN
38401-4672
US

V. Phone/Fax

Practice location:
  • Phone: 931-380-0075
  • Fax: 931-388-7502
Mailing address:
  • Phone: 931-380-0075
  • Fax: 931-388-7502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6275
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: