Healthcare Provider Details

I. General information

NPI: 1326828732
Provider Name (Legal Business Name): HALLEA DIXON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 ROWAN CT
MARIETTA GA
30066-2752
US

IV. Provider business mailing address

1424 ROWAN CT
MARIETTA GA
30066-2752
US

V. Phone/Fax

Practice location:
  • Phone: 808-333-4044
  • Fax:
Mailing address:
  • Phone: 808-333-4044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number1-174592
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: