Provider Demographics
NPI:1386371979
Name:DIXON, CAROL S
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:S
Last Name:DIXON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3946 GLEN PARK DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-3694
Mailing Address - Country:US
Mailing Address - Phone:404-290-4306
Mailing Address - Fax:
Practice Address - Street 1:3946 GLEN PARK DR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-3694
Practice Address - Country:US
Practice Address - Phone:404-290-4306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider