MEDICARE: DR. MICHAEL WADE DIXON DPM

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	213E00000X	Podiatrist	000961	GA
2	213ES0000X	Sports Medicine Podiatrist	000961	GA
3	213ES0103X	Foot & Ankle Surgery Podiatrist	000961	GA
4	213ES0131X	Foot Surgery Podiatrist	000961	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477557924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL WADE DIXON DPM

Provider Business Mailing Address
First Line	:	440 ERNEST W BARRETT PKWY NW
Second Line	:	STE 62
City	:	KENNESAW
State	:	GA
Zip	:	30144-4918
Country	:	US
Telephone Number	:	770-422-0280
Fax Number	:	770-426-5388

Provider Business Practice Location Address
First Line	:	440 ERNEST W BARRETT PKWY NW
Second Line	:	STE 62
City	:	KENNESAW
State	:	GA
Zip	:	30144-4918
Country	:	US
Telephone Number	:	770-422-0280
Fax Number	:	770-426-5388

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	01/14/2014

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