Healthcare Provider Details

I. General information

NPI: 1154625549
Provider Name (Legal Business Name): DICKSON EAR, NOSE & THROAT PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2010
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 CRESTVIEW PARK DR SUITE 2
DICKSON TN
37055-2850
US

IV. Provider business mailing address

125 CRESTVIEW PARK DR SUITE 2
DICKSON TN
37055-2850
US

V. Phone/Fax

Practice location:
  • Phone: 615-740-5233
  • Fax: 615-740-5226
Mailing address:
  • Phone: 615-740-5233
  • Fax: 615-740-5226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number38445
License Number StateTN

VIII. Authorized Official

Name: MS. LEIGH ANN DIXON
Title or Position: OFFICE MANAGER
Credential:
Phone: 615-740-5233