Provider Demographics
NPI:1992701064
Name:DIXON, HAMILTON S (MD)
Entity type:Individual
Prefix:DR
First Name:HAMILTON
Middle Name:S
Last Name:DIXON
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 1:3268 MARTHA BERRY HWY NE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-7712
Mailing Address - Country:US
Mailing Address - Phone:706-235-4411
Mailing Address - Fax:706-232-3561
Practice Address - Street 1:3268 MARTHA BERRY HWY NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-7712
Practice Address - Country:US
Practice Address - Phone:706-235-4411
Practice Address - Fax:706-232-3561
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011702207YS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000070562AMedicaid
GA111702040AMedicare PIN
GA000070562AMedicaid