Provider Demographics
NPI:1265636757
Name:RICKARD, DORSEY ANDREWS (MD)
Entity Type:Individual
Prefix:
First Name:DORSEY
Middle Name:ANDREWS
Last Name:RICKARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DORSEY
Other - Middle Name:
Other - Last Name:THORLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1607 WESTGATE CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8077
Mailing Address - Country:US
Mailing Address - Phone:615-376-8195
Mailing Address - Fax:615-376-2601
Practice Address - Street 1:1607 WESTGATE CIR STE 200
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8077
Practice Address - Country:US
Practice Address - Phone:615-376-8195
Practice Address - Fax:615-376-2601
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46408208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1523484Medicaid
TN10311I5642Medicare PIN