Provider Demographics
NPI:1548412885
Name:DICKSON ORTHOPAEDIC AND SPORTS MEDICINE PLLC
Entity type:Organization
Organization Name:DICKSON ORTHOPAEDIC AND SPORTS MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:NORTON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:615-740-0080
Mailing Address - Street 1:196 HILLVIEW ST
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-1285
Mailing Address - Country:US
Mailing Address - Phone:615-740-0080
Mailing Address - Fax:615-467-8797
Practice Address - Street 1:196 HILLVIEW ST
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-1285
Practice Address - Country:US
Practice Address - Phone:615-740-0080
Practice Address - Fax:615-467-8797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1511190Medicaid
TN3370375Medicare PIN
TN1511190Medicaid