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General NPI Number Information
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NPI Number | 1184098832
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Entity Type | Individual
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Provider Name | DIXIE MAYBERRY PA
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Gender | Female
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Dates
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Enumeration Date | 11/18/2015
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Last Update Date | 02/26/2024
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Provider Practice Location Address
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Address Line | 818 CHURCH ST NE
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City | MARIETTA
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State | GA
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Zip | 30060-8981
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Country | US
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Telephone | 770-590-4190
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Fax | 770-590-4191
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Provider Business Mailing Address
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Address Line | 818 CHURCH ST NE
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City | MARIETTA
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State | GA
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Zip | 30060-8981
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Country | US
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Telephone | 770-590-4190
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Fax | 770-590-4191
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 2476
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 9782
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License Number State | GA
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