=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932183217
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM CARROLL HIXSON MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2005
-----------------------------------------------------
Last Update Date | 12/18/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1047 FAIRHOPE AVE
-----------------------------------------------------
City | FAIRHOPE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36532-3145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-990-1850
-----------------------------------------------------
Fax | 251-990-1851
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 40430
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36640-0430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-434-3626
-----------------------------------------------------
Fax | 251-445-2464
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number | MD.15856
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------