=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215581392
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUMMER DIXON HILL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2019
-----------------------------------------------------
Last Update Date | 06/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1912 MEMORIAL DR STE E
-----------------------------------------------------
City | WAYCROSS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31501-0989
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-283-7100
-----------------------------------------------------
Fax | 912-283-7109
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3936 FOLKS CIR
-----------------------------------------------------
City | BLACKSHEAR
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31516-8430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-282-3325
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN248756
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------