Healthcare Provider Details

I. General information

NPI: 1093628992
Provider Name (Legal Business Name): WADE DICKERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MEDICAL CENTER PKWY
MURFREESBORO TN
37129-2245
US

IV. Provider business mailing address

1700 MEDICAL CENTER PKWY
MURFREESBORO TN
37129-2245
US

V. Phone/Fax

Practice location:
  • Phone: 629-242-0666
  • Fax:
Mailing address:
  • Phone: 629-242-0666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number43429
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: