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General NPI Number Information
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NPI Number | 1811964539
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Entity Type | Individual
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Provider Name | PIERCE KENDAL DIXON III MD
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Gender | Male
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Dates
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Enumeration Date | 03/01/2006
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Last Update Date | 01/04/2011
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Provider Practice Location Address
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Address Line | 690 MEDICAL PARK LANE
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City | GAINESVILLE
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State | GA
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Zip | 30501
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Country | US
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Telephone | 770-531-0093
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Fax | 770-535-0094
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Provider Business Mailing Address
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Address Line | 690 MEDICAL PARK LANE
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City | GAINESVILLE
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State | GA
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Zip | 30501
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Country | US
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Telephone | 770-531-0093
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Fax | 770-535-0094
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 18484
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License Number State | GA
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