Individual
MARIO S. DICKENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
6116 SHALLOWFORD RD, STE 118, CHATTANOOGA, TN 37421-7201
(423) 710-1224
(423) 710-1228
Mailing address
6116 SHALLOWFORD RD, STE 118, CHATTANOOGA, TN 37421-7201
(423) 710-1224
(423) 710-1228
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
690
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1512827
—
TN
05
—
4342355
—
MI
01
—
P00744501
RAILROAD MEDICARE
—
Enumeration date
05/31/2006
Last updated
03/11/2015
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