Healthcare Provider Details

I. General information

NPI: 1992701064
Provider Name (Legal Business Name): HAMILTON S DIXON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3268 MARTHA BERRY HWY NE
ROME GA
30165-7712
US

IV. Provider business mailing address

3268 MARTHA BERRY HWY NE
ROME GA
30165-7712
US

V. Phone/Fax

Practice location:
  • Phone: 706-235-4411
  • Fax: 706-232-3561
Mailing address:
  • Phone: 706-235-4411
  • Fax: 706-232-3561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number011702
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: