Healthcare Provider Details

I. General information

NPI: 1578569604
Provider Name (Legal Business Name): DAVID E. PICKERING PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 12/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

367B N PARKWAY STE 1
JACKSON TN
38305-2899
US

IV. Provider business mailing address

78 CHIP OAK DR
MEDON TN
38356-8128
US

V. Phone/Fax

Practice location:
  • Phone: 731-668-2277
  • Fax: 731-660-0510
Mailing address:
  • Phone: 731-668-2277
  • Fax: 731-660-0510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP-1223
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: