Healthcare Provider Details

I. General information

NPI: 1710964416
Provider Name (Legal Business Name): WILLIAM M DIXON III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHIP DIXON MD

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WHEELER AVE
PROSPERITY SC
29127
US

IV. Provider business mailing address

PO BOX 630
PROSPERITY SC
29127-0630
US

V. Phone/Fax

Practice location:
  • Phone: 803-364-4852
  • Fax: 803-364-2014
Mailing address:
  • Phone: 803-364-4852
  • Fax: 803-364-2014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22715
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: