Provider Demographics
NPI:1942290333
Name:DICKERSON, REGINALD PEELER (MD)
Entity Type:Individual
Prefix:
First Name:REGINALD
Middle Name:PEELER
Last Name:DICKERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 GREAT CIRCLE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1317
Mailing Address - Country:US
Mailing Address - Phone:615-451-9200
Mailing Address - Fax:615-989-4217
Practice Address - Street 1:300 STEAM PLANT RD
Practice Address - Street 2:SUITE 300
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3032
Practice Address - Country:US
Practice Address - Phone:615-451-9200
Practice Address - Fax:615-989-4217
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN43777207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00702357OtherRR MEDICARE
TN1507710Medicaid
TN6011931OtherBCBS
TNP00702357OtherRR MEDICARE
A80353Medicare UPIN