Provider Demographics
NPI:1588906499
Name:MIXSON, ARCHIBALD JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:ARCHIBALD
Middle Name:JAMES
Last Name:MIXSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15620 THISTLEBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-3227
Mailing Address - Country:US
Mailing Address - Phone:410-706-3223
Mailing Address - Fax:
Practice Address - Street 1:15620 THISTLEBRIDGE DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20853-3227
Practice Address - Country:US
Practice Address - Phone:410-706-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0035064207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism