Provider Demographics
NPI:1457651911
Name:DICKSON PAIN AND WELLNESS PLLC
Entity Type:Organization
Organization Name:DICKSON PAIN AND WELLNESS PLLC
Other - Org Name:NASHVILLE PAIN CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDENER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:615-516-3840
Mailing Address - Street 1:118 HIGHWAY 70 E
Mailing Address - Street 2:SUITE #1
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-7039
Mailing Address - Country:US
Mailing Address - Phone:615-446-4999
Mailing Address - Fax:615-326-0099
Practice Address - Street 1:118 HIGHWAY 70 E
Practice Address - Street 2:SUITE #1
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-7039
Practice Address - Country:US
Practice Address - Phone:615-446-4999
Practice Address - Fax:615-326-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11005363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty