Healthcare Provider Details

I. General information

NPI: 1003454349
Provider Name (Legal Business Name): DAVID ANDREW VINCENT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 HENSLEE DR
DICKSON TN
37055-2166
US

IV. Provider business mailing address

403 HENSLEE DR
DICKSON TN
37055-2166
US

V. Phone/Fax

Practice location:
  • Phone: 615-637-3131
  • Fax: 931-208-3616
Mailing address:
  • Phone: 615-637-3131
  • Fax: 931-208-3616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4355
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: