Healthcare Provider Details

I. General information

NPI: 1942675533
Provider Name (Legal Business Name): MR. MAXIE SHERWOOD DIXON JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2015
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 HILLSBOROUGH RD STE B DURHAM FESTIVAL MALL
DURHAM NC
27705-3041
US

IV. Provider business mailing address

1682 MANCHESTER DR
RALEIGH NC
27609
US

V. Phone/Fax

Practice location:
  • Phone: 919-286-1601
  • Fax: 919-484-0899
Mailing address:
  • Phone: 919-286-1601
  • Fax: 919-484-0899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number853
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: