Provider Demographics
NPI:1912015108
Name:DICKSON MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:DICKSON MEDICAL ASSOCIATES, PC
Other - Org Name:DMA LYLES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LIGHTHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-441-4477
Mailing Address - Street 1:127 CRESTVIEW PARK DR
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2855
Mailing Address - Country:US
Mailing Address - Phone:615-446-5121
Mailing Address - Fax:615-446-1357
Practice Address - Street 1:5194 HIGHWAY 100
Practice Address - Street 2:SUITE 106
Practice Address - City:LYLES
Practice Address - State:TN
Practice Address - Zip Code:37098-2821
Practice Address - Country:US
Practice Address - Phone:931-670-1102
Practice Address - Fax:615-446-1357
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DICKSON MEDICAL ASSOCIATES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-28
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3721355Medicaid
TN3158185OtherBCBS TN GROUP PIN
TN3158185OtherBCBS TN GROUP PIN
TN3721355Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER