Organization
TENNESSEE PLATEAU ONCOLOGY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIRK C DAVIDSON M.D. (SOLE OWNER)
(931) 484-7596
Entity
Organization
Contact information
Practice address
33 W ADAMS ST, CROSSVILLE, TN 38555-4836
(931) 484-7596
(931) 484-7597
Mailing address
33 W ADAMS ST, CROSSVILLE, TN 38555-4836
(931) 484-7596
(931) 484-7597
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD21772
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3890077
—
TN
01
—
P00102649
RR MEDICARE
TN
Enumeration date
07/15/2008
Last updated
12/28/2022
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