Provider Demographics
NPI:1508163833
Name:DICKERSON, JAY STANLEY
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:STANLEY
Last Name:DICKERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8619 SAWYER BROWN RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-2482
Mailing Address - Country:US
Mailing Address - Phone:615-390-1263
Mailing Address - Fax:
Practice Address - Street 1:2176 HILLSBORO RD STE 124
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37069-6236
Practice Address - Country:US
Practice Address - Phone:615-791-0394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist