Healthcare Provider Details

I. General information

NPI: 1194061291
Provider Name (Legal Business Name): NATHAN S DOTSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2012
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HIGHWAY 70 E
DICKSON TN
37055-2080
US

IV. Provider business mailing address

PO BOX 2127
SMYRNA TN
37167-1711
US

V. Phone/Fax

Practice location:
  • Phone: 615-446-0446
  • Fax:
Mailing address:
  • Phone: 844-673-6968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2224
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: