Healthcare Provider Details

I. General information

NPI: 1871191395
Provider Name (Legal Business Name): LUCINDA A DIXON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2020
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 LOGANVILLE HIGHWAY
BETHLEHEM GA
30620
US

IV. Provider business mailing address

1231 FINCH RD
WINDER GA
30680-3220
US

V. Phone/Fax

Practice location:
  • Phone: 470-900-2960
  • Fax: 678-407-8741
Mailing address:
  • Phone: 770-307-8410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH017218
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH017218
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: