Healthcare Provider Details

I. General information

NPI: 1689777922
Provider Name (Legal Business Name): DICKSON MEDICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 E COLLEGE ST
DICKSON TN
37055-2032
US

IV. Provider business mailing address

127 CRESTVIEW PARK DR
DICKSON TN
37055-2855
US

V. Phone/Fax

Practice location:
  • Phone: 615-441-4504
  • Fax: 615-446-1357
Mailing address:
  • Phone: 615-446-5121
  • Fax: 615-446-1357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS CINDY A LIGHTHILL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 615-441-4477