Healthcare Provider Details

I. General information

NPI: 1841296514
Provider Name (Legal Business Name): ANDREW ALEXANDER DIXON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 SNAPFINGER PARK DR STE 110
DECATUR GA
30035-4066
US

IV. Provider business mailing address

5255 SNAPFINGER PARK DR STE 110
DECATUR GA
30035-4066
US

V. Phone/Fax

Practice location:
  • Phone: 770-981-2211
  • Fax: 770-981-0208
Mailing address:
  • Phone: 770-981-2211
  • Fax: 770-981-0208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number28761
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number028761
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: