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General NPI Number Information
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NPI Number | 1992885008
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Entity Type | Individual
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Provider Name | RALPH THOMAS DIXON JR. L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 11/28/2012
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Provider Practice Location Address
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Address Line | 35 COLLIER RD NW SUITE M-215
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City | ATLANTA
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State | GA
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Zip | 30309-1613
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Country | US
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Telephone | 404-355-2914
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Fax | 404-355-2917
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Provider Business Mailing Address
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Address Line | 35 COLLIER RD NW SUITE M-215
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City | ATLANTA
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State | GA
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Zip | 30309-1613
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Country | US
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Telephone | 404-355-2914
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Fax | 404-355-2917
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW000606
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License Number State | GA
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