Healthcare Provider Details

I. General information

NPI: 1558061671
Provider Name (Legal Business Name): DANA DIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7138 HIGHWAY 212
COVINGTON GA
30016-8047
US

IV. Provider business mailing address

7138 HIGHWAY 212
COVINGTON GA
30016-8047
US

V. Phone/Fax

Practice location:
  • Phone: 404-902-7972
  • Fax: 770-200-1563
Mailing address:
  • Phone: 404-902-7972
  • Fax: 770-200-1563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2829402
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: