Provider Demographics
NPI:1992883995
Name:DIXON, ELLIS HOWARD III (MD)
Entity type:Individual
Prefix:DR
First Name:ELLIS
Middle Name:HOWARD
Last Name:DIXON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1645 TULLIE CIR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2304
Mailing Address - Country:US
Mailing Address - Phone:404-785-7130
Mailing Address - Fax:404-785-7989
Practice Address - Street 1:1645 TULLIE CIR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2304
Practice Address - Country:US
Practice Address - Phone:404-785-7130
Practice Address - Fax:404-785-7989
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA32549207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine