Provider Demographics
NPI:1316961410
Name:ADKISSON, DANIEL J (PA)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:ADKISSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 711
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37056-0711
Mailing Address - Country:US
Mailing Address - Phone:615-446-0522
Mailing Address - Fax:615-446-4737
Practice Address - Street 1:219 CHURCH ST
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-1303
Practice Address - Country:US
Practice Address - Phone:615-446-0522
Practice Address - Fax:615-446-4737
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN77363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4078391OtherBLUE CROSS BLUE SHIELD
TN3725526Medicaid
TNS12633Medicare UPIN
TN3725526Medicaid