Healthcare Provider Details

I. General information

NPI: 1710270947
Provider Name (Legal Business Name): PAUL T DIXON JR. CP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2011
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 CHESTNUT TRL
COHUTTA GA
30710-9375
US

IV. Provider business mailing address

4205 CHESTNUT TRL
COHUTTA GA
30710-9375
US

V. Phone/Fax

Practice location:
  • Phone: 859-609-7153
  • Fax:
Mailing address:
  • Phone: 859-609-7153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO03648
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: