MEDICARE: DR. JENNIFER RENEE DIXON PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1200X	Pharmacotherapy Pharmacist	0202206227	VA
2	1835P1200X	Pharmacotherapy Pharmacist	17417	NC
3	183500000X	Pharmacist	RPH022889	GA

General Provider Information

NPI Number	:	1760474167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER RENEE DIXON PHARM.D.

Provider Business Mailing Address
First Line	:	1274 WINDSOR PKWY NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30319-2651
Country	:	US
Telephone Number	:	404-216-0836
Fax Number	:

Provider Business Practice Location Address
First Line	:	4975 WINDWARD PKWY
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30004-8558
Country	:	US
Telephone Number	:	678-366-0472
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	05/05/2011

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