Healthcare Provider Details

I. General information

NPI: 1912015108
Provider Name (Legal Business Name): DICKSON MEDICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5194 HIGHWAY 100 SUITE 106
LYLES TN
37098-2821
US

IV. Provider business mailing address

127 CRESTVIEW PARK DR
DICKSON TN
37055-2855
US

V. Phone/Fax

Practice location:
  • Phone: 931-670-1102
  • Fax: 615-446-1357
Mailing address:
  • Phone: 615-446-5121
  • Fax: 615-446-1357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MISS CINDY A LIGHTHILL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 615-441-4477