MEDICARE: CHRISTOPHER LOUIS WIXON M.D.

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	208600000X	Surgery Physician	22196	SC
2	2086S0129X	Vascular Surgery Physician	049122	GA
3	2086S0129X	Vascular Surgery Physician	22196	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10065827	OTHER	GA	AMERIGROUP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	349840	OTHER	GA	WELLCARE OF GA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407882582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER LOUIS WIXON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 37643
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-1218
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 PERSIMMONS ST
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29910-4779
Country	:	US
Telephone Number	:	912-629-7800
Fax Number	:	854-235-2822

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	02/04/2026

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