Healthcare Provider Details

I. General information

NPI: 1821935917
Provider Name (Legal Business Name): JERRICA DIXON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 MATTHEW DR STE A
WAYNESBORO MS
39367-2566
US

IV. Provider business mailing address

951 MATTHEW DR STE A
WAYNESBORO MS
39367-2566
US

V. Phone/Fax

Practice location:
  • Phone: 601-735-2401
  • Fax:
Mailing address:
  • Phone: 601-735-2401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: