# CHARLES H. DICKERSON

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578589503
- **Authorized official:** MR. CHARLES H DICKERSON RADIOLOGIC TECHNOLOG (OWNER)
- **Authorized official phone:** (903) 596-9729

## Contact information

- **Practice address:** 2208 OLD HENDERSON HWY, TYLER, TX 75702-6457
- **Practice address phone:** (903) 596-9729
- **Practice address fax:** (903) 596-7206
- **Mailing address:** PO BOX 9700, TYLER, TX 75711-2700
- **Mailing address phone:** (903) 596-9729
- **Mailing address fax:** (903) 596-7206

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0208X | Mobile Radiology Clinic/Center | 6309 | TX | Yes |

## Other

- **Enumeration date:** 07/14/2006
- **Last updated:** 06/30/2014