Healthcare Provider Details

I. General information

NPI: 1780894329
Provider Name (Legal Business Name): CALVIN LIONEL DIXON RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 OLD HWY 84 NO. 1
NATCHEZ MS
39120-0764
US

IV. Provider business mailing address

PO BOX 764
WASHINGTON MS
39190-0764
US

V. Phone/Fax

Practice location:
  • Phone: 225-772-6807
  • Fax: 601-304-9400
Mailing address:
  • Phone: 225-772-6807
  • Fax: 601-304-9400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number113330
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: