Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 11347 | TN |
NPI | 1326645623 |
---|---|
Provider Name | Dr. Martha Dawson Nicholson |
First Address | Clarksville, TN 37043-8331 |
Second Address | Dover, TN 37058-3302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2020 |
Last Update Date | 08/10/2020 |