Provider Demographics
NPI:1184697898
Name:DOZIER, KENNETH C (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:C
Last Name:DOZIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1210 BRIARVILLE RD
Mailing Address - Street 2:BLDG F
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5141
Mailing Address - Country:US
Mailing Address - Phone:615-860-0708
Mailing Address - Fax:615-860-8325
Practice Address - Street 1:1210 BRIARVILLE RD
Practice Address - Street 2:BLDG F
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-5141
Practice Address - Country:US
Practice Address - Phone:615-860-0708
Practice Address - Fax:615-860-8325
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-12
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD7525207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3164627Medicare PIN
F69393Medicare UPIN