MEDICARE: DONTAVIOUS NIXON

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1952976268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONTAVIOUS NIXON

Provider Business Mailing Address
First Line	:	71 SPALDING TRL
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-1067
Country	:	US
Telephone Number	:	239-219-3590
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 HIGHTOWER TRL STE B120
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350-6205
Country	:	US
Telephone Number	:	866-523-4268
Fax Number	:

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

Provider Enumeration Date	:	05/20/2021
Last Update Date	:	05/20/2021

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Directions to “ DONTAVIOUS NIXON ” Practice Location

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