1336105188 NPI number — ELIZABETH M DIXON M.D.

Table of content: ELIZABETH M DIXON M.D. (NPI 1336105188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336105188 NPI number — ELIZABETH M DIXON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIXON
Provider First Name:
ELIZABETH
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336105188
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4025 ANSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALPHARETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30022-1134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-435-0198
Provider Business Mailing Address Fax Number:
770-709-6910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3925 JOHNS CREEK COURT
Provider Second Line Business Practice Location Address:
SUTIE A
Provider Business Practice Location Address City Name:
SUWANEE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-709-6922
Provider Business Practice Location Address Fax Number:
770-709-6910
Provider Enumeration Date:
04/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  61985 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 35.134792 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: C1-0012870 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 58114 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: ME138304 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 070877 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 023757 . This is a "SIHO" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P00293086 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64273162 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000381952 . This is a "ANTHEM - NICC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000756575 . This is a "ANTHEM- NCMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 201055170 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50037115 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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