MEDICARE: ROSALIE THERESE DIXSON CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	APRN-CNM297990	GA
2	163W00000X	Registered Nurse	RN297990	GA

General Provider Information

NPI Number	:	1053093369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSALIE THERESE DIXSON CNM

Provider Business Mailing Address
First Line	:	3400 OLD MILTON PKWY STE C270
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-4414
Country	:	US
Telephone Number	:	404-497-1350
Fax Number	:	404-497-1352

Provider Business Practice Location Address
First Line	:	4181 HOSPITAL DR NE STE 104&100
Second Line	:
City	:	COVINGTON
State	:	GA
Zip	:	30014-2541
Country	:	US
Telephone Number	:	770-385-8954
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2023
Last Update Date	:	04/10/2026

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