Healthcare Provider Details

I. General information

NPI: 1477820934
Provider Name (Legal Business Name): DIXON MEDICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 CANDY PARK ROAD 5101
PEMBROKE NC
28372-7322
US

IV. Provider business mailing address

3771 RAMSEY ST STE 109-237
FAYETTEVILLE NC
28311-7675
US

V. Phone/Fax

Practice location:
  • Phone: 910-522-1143
  • Fax: 910-522-1162
Mailing address:
  • Phone: 910-488-7777
  • Fax: 910-488-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2010-01347
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number201001347
License Number StateNC

VIII. Authorized Official

Name: DONOVAN DIXON
Title or Position: CEO
Credential: MD
Phone: 347-831-1259