Dickson Medical Associates, PC
Organization Active NPI Rural Health Clinic/Center · Waverly, TN
NPI 1730835356 · NPPES record last updated Feb 23, 2022
Key facts
- NPI
- 1730835356
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- DICKSON MEDICAL ASSOCIATES, PC
- Practice address
- 300 S Clydeton Rd
Waverly, TN 37185-2140 - Phone
- (615) 446-5121
- Fax
- (615) 446-1359
- NPI assigned
- Feb 22, 2022
- Organization subpart
- No
Authorized official
- Name
- Christie Strong
- Title
- Executive Director
- Phone
- (615) 446-1324
Owners & managing parties with NPI records 21
-
David J Blazer, MD
-
William Wesley Brewer, M.D.
-
Jeffrey Alan Culp, M.D.
-
Howard Marc Hammer, D.O.
-
Vera H Huffnagle, MD
-
Ehab S Kasasbeh, M.D.
-
Dolores J Lucas, MD
-
Mary K McNeal, MD
-
Enawgaw B Mehari, M.D.
-
Robert W Orgain, MD
-
David L Ross, MD
-
Kerry W Ross, MD
-
Matthew L Sarb, D.O.
-
Demond C. White, MD
Other NPIs with the same Medicare PAC ID 11
Corporate family (same tax ID) 9
Practitioners 55
-
James R Anderson, MD
-
David J Blazer, MD
-
Daniel Braughton, DPT
-
William Wesley Brewer, M.D.
-
Anita Kaye Callahan, APN
-
Heather Coates, P.A.-C
-
Alexandria Lynnly Cole, APRN
-
Jeffrey Alan Culp, M.D.
-
Lori Ann Green, FNP-BC
-
Tracy D Gregory, FNP-C
-
Howard Marc Hammer, D.O.
-
Lauren Hay, PA-C
-
Vera H Huffnagle, MD
-
Lora Johnson, MD
-
Kacey Elizabeth Jumper, AU.D.
-
Ehab S Kasasbeh, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Rural health clinic certification: CCN 883924
- Legal name
- DICKSON MEDICAL ASSOCIATES, PC
- Doing business as
- DMA PEDIATRICS AND SPECIALTY CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Nov 30, 2022
- Last certification
- Nov 30, 2022
- Ownership / control type
- 1B
- Organization structure
- Corporation · Proprietary
- Incorporated
- Jan 1, 2001 in TN
- Enrollment address
- 300 S Clydeton Rd
Waverly, TN 37185-2140
All disclosed owners & managing parties 22
| Name | Role | Since | Share |
|---|---|---|---|
| Kerry W Ross |
5% Or Greater Direct Ownership Interest | Jul 26, 2004 | 4.93% |
| Corporate Officer |
Sep 29, 2025 | ||
| Jeffrey Alan Culp |
5% Or Greater Direct Ownership Interest | Nov 6, 2023 | 4.93% |
| Demond C White |
5% Or Greater Direct Ownership Interest | Apr 1, 2014 | 4.93% |
| Matthew L Sarb |
5% Or Greater Direct Ownership Interest | Apr 1, 2022 | 4.93% |
| Patrick M Luchini |
5% Or Greater Direct Ownership Interest | Dec 30, 2025 | 4.93% |
| Deline Kirubanathan |
5% Or Greater Direct Ownership Interest | Apr 1, 2022 | 4.93% |
| Caroline Farrar |
5% Or Greater Direct Ownership Interest | Jun 24, 2025 | 4.93% |
| Daniel J Sherwood |
5% Or Greater Direct Ownership Interest | Nov 1, 2020 | 4.93% |
| Mary K McNeal |
5% Or Greater Direct Ownership Interest | Sep 1, 2004 | 4.93% |
| Corporate Officer |
Sep 29, 2025 | 100% | |
| Dolores J Lucas |
5% Or Greater Direct Ownership Interest | Jul 1, 2007 | 2.4% |
| David J Blazer |
5% Or Greater Direct Ownership Interest | Jan 1, 2001 | 4.43% |
| Enawgaw B Mehari |
5% Or Greater Direct Ownership Interest | May 1, 2023 | 4.93% |
| Vera H Huffnagle |
5% Or Greater Direct Ownership Interest | Jan 1, 2001 | 4.93% |
| Ehab S Kasasbeh |
5% Or Greater Direct Ownership Interest | Jul 23, 2014 | 4.93% |
| John Bradford McDonough |
5% Or Greater Direct Ownership Interest | Jul 9, 2025 | 4.93% |
| Christie Strong |
Operational/Managerial Control | Jan 1, 2001 | |
| William Brewer |
5% Or Greater Direct Ownership Interest | Mar 31, 2021 | 4.93% |
| Corporate Director |
Jan 1, 2025 | ||
| Abigail L Ryan |
5% Or Greater Direct Ownership Interest | Nov 6, 2023 | 4.93% |
| David L Ross |
5% Or Greater Direct Ownership Interest | Aug 1, 2004 | 4.93% |
| Robert W Orgain |
5% Or Greater Direct Ownership Interest | May 29, 1987 | 4.43% |
| Mohammad a Alsoub |
5% Or Greater Direct Ownership Interest | Apr 1, 2022 | 4.93% |
| Howard M Hammer |
5% Or Greater Direct Ownership Interest | Feb 15, 2024 | 4.93% |
| Corporate Director |
Jan 1, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220314002231 | TN | Part a Provider - Rural Health Clinic | 3971408774 | Practice locations: Waverly, TN |
National Provider Directory
- Tax ID family
- Jackson Clinic Prof Ass
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
300 S Clydeton Rd
Waverly, TN 37185-2140
Mailing address
127 Crestview Park Dr Ste 209
Dickson, TN 37055-2856
Phone (615) 441-4478
Other names
- DMA Pediatrics and Specialty Clinic
Other providers in Waverly, TN
- Daniel Terry Cole
- Mary B. Davis
- Richard Lee Davis
- Amanda Deason
- Dialysis Clinic Inc.
- Dickson Medical Associates, PC
- Daniel Robert Dillard
- Karen Michelle Dixon
- Noel R Dominguez
- Melanie Leigh Dowling
All providers in Waverly, TN · Rural Health Clinic/Center in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 23, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.