Healthcare Provider Details

I. General information

NPI: 1689296444
Provider Name (Legal Business Name): PHILLIP EVERETT DIXON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S MAIN ST STE 100
REIDSVILLE NC
27320-5034
US

IV. Provider business mailing address

701 GROVE RD
GREENVILLE SC
29605-4210
US

V. Phone/Fax

Practice location:
  • Phone: 336-951-6460
  • Fax:
Mailing address:
  • Phone: 864-455-7882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2023-01182
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: