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NPI Code Detail

MEDICARE: MR. WILLIE LEE DODSON JR. PA

MEDICARE: MR. WILLIE LEE DODSON JR. PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant6344TN

General Provider Information

NPI Number : 1285367797
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. WILLIE LEE DODSON JR. PA
Provider Business Mailing Address
First Line : 8415 KING WILLIAM ST
Second Line :
City : CORDOVA
State : TN
Zip : 38016-5199
Country : US
Telephone Number : 858-354-3250
Fax Number :
Provider Business Practice Location Address
First Line : 650 E PARKWAY S
Second Line :
City : MEMPHIS
State : TN
Zip : 38104-5568
Country : US
Telephone Number : 901-321-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2022
Last Update Date : 03/06/2026

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