Healthcare Provider Details

I. General information

NPI: 1043076524
Provider Name (Legal Business Name): ROSEMARY DIXON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 02/22/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 BUFORD HWY STE 1001-19
SUWANEE GA
30024-7808
US

IV. Provider business mailing address

500 BUFORD HWY STE 1001-19
SUWANEE GA
30024-7808
US

V. Phone/Fax

Practice location:
  • Phone: 770-744-2382
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC007499
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number749857
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: