Provider Demographics
NPI:1508923129
Name:DODSON, JAMES M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:DODSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 WEATHERLY DR
Mailing Address - Street 2:STE F
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8915
Mailing Address - Country:US
Mailing Address - Phone:931-494-7131
Mailing Address - Fax:931-548-1776
Practice Address - Street 1:298 WARFIELD BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-1828
Practice Address - Country:US
Practice Address - Phone:931-494-7131
Practice Address - Fax:931-548-1776
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1942103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1519218Medicaid
TN1519218Medicaid