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General NPI Number Information
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NPI Number | 1053575472
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Entity Type | Organization
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Legal Business Name | TENNESSEE PLATEAU ONCOLOGY PLLC
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Dates
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Enumeration Date | 07/15/2008
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Last Update Date | 12/28/2022
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Provider Practice Location Address
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Address Line | 33 W ADAMS ST
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City | CROSSVILLE
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State | TN
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Zip | 38555-4836
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Country | US
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Telephone | 931-484-7596
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Fax | 931-484-7597
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Provider Business Mailing Address
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Address Line | 33 W ADAMS ST
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City | CROSSVILLE
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State | TN
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Zip | 38555-4836
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Country | US
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Telephone | 931-484-7596
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Fax | 931-484-7597
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Authorized Official
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Title or Position | SOLE OWNER
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Name | DR. DIRK C DAVIDSON
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Credential | M.D.
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Telephone | 931-484-7596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD21772
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License Number State | TN
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