Provider Demographics
NPI:1477795227
Name:DORSEY, LINDA (HEARING)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:DORSEY
Suffix:
Gender:F
Credentials:HEARING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2538 KEITH ST NW STE 8
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3738
Mailing Address - Country:US
Mailing Address - Phone:423-478-3085
Mailing Address - Fax:423-339-9524
Practice Address - Street 1:2538 KEITH ST NW STE 8
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3738
Practice Address - Country:US
Practice Address - Phone:423-478-3085
Practice Address - Fax:423-339-9524
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN491174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN20-3458680OtherBLUECROSS BLUESHIELD