Healthcare Provider Details

I. General information

NPI: 1508163833
Provider Name (Legal Business Name): DR. JAY STANLEY DICKERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2011
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2176 HILLSBORO RD STE 124
FRANKLIN TN
37069-6236
US

IV. Provider business mailing address

8619 SAWYER BROWN RD
NASHVILLE TN
37221-2482
US

V. Phone/Fax

Practice location:
  • Phone: 615-791-0394
  • Fax:
Mailing address:
  • Phone: 615-390-1263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: