Healthcare Provider Details

I. General information

NPI: 1407545809
Provider Name (Legal Business Name): SHAMAYE DIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 WESTVIEW DR SW
ATLANTA GA
30310-1458
US

IV. Provider business mailing address

3693 WOODSTONE DR
LEWIS CENTER OH
43035-9386
US

V. Phone/Fax

Practice location:
  • Phone: 404-756-1959
  • Fax:
Mailing address:
  • Phone: 614-499-7386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: