Individual
MR. RUSSELL ERIC DICKENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
10800 PARKSIDE DR STE 331, KNOXVILLE, TN 37934-1922
(865) 392-3400
(865) 392-3449
Mailing address
10800 PARKSIDE DR STE 331, KNOXVILLE, TN 37934-1922
(865) 392-3400
(865) 392-3449
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
100
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3665210
—
TN
Enumeration date
10/26/2005
Last updated
09/14/2020
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