Provider Demographics
NPI:1164586186
Name:DOGWOOD CLINIC INC
Entity Type:Organization
Organization Name:DOGWOOD CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-286-6209
Mailing Address - Street 1:1385 FLOWERING DOGWOOD LN
Mailing Address - Street 2:SUITE D
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-6409
Mailing Address - Country:US
Mailing Address - Phone:731-286-6209
Mailing Address - Fax:
Practice Address - Street 1:1385 FLOWERING DOGWOOD LN
Practice Address - Street 2:SUITE D
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-6409
Practice Address - Country:US
Practice Address - Phone:731-286-6209
Practice Address - Fax:731-285-3600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty