Healthcare Provider Details

I. General information

NPI: 1790797595
Provider Name (Legal Business Name): JO ELLYN DYSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 COOL SPRINGS BLVD
FRANKLIN TN
37067-2677
US

IV. Provider business mailing address

200 COOL SPRINGS BLVD
FRANKLIN TN
37067-2677
US

V. Phone/Fax

Practice location:
  • Phone: 615-771-7546
  • Fax: 615-771-8600
Mailing address:
  • Phone: 615-771-7546
  • Fax: 615-771-8600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0000000583
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: