MEDICARE: DICKSON MEDICAL ASSOCIATES, PC

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
1	2086S0129X	Vascular Surgery Physician
2	208600000X	Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3158185	OTHER	TN	BCBS TN GROUP PIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689777922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DICKSON MEDICAL ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	127 CRESTVIEW PARK DR
Second Line	:
City	:	DICKSON
State	:	TN
Zip	:	37055-2855
Country	:	US
Telephone Number	:	615-446-5121
Fax Number	:	615-446-1357

Provider Business Practice Location Address
First Line	:	704 E COLLEGE ST
Second Line	:
City	:	DICKSON
State	:	TN
Zip	:	37055-2032
Country	:	US
Telephone Number	:	615-441-4504
Fax Number	:	615-446-1357

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MISS CINDY A LIGHTHILL
Credential	:
Telephone Number	:	615-441-4477

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	09/20/2012

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