Provider Demographics
NPI:1053319731
Name:DIXON, EL-ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:EL-ROY
Middle Name:
Last Name:DIXON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71445
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31708-1445
Mailing Address - Country:US
Mailing Address - Phone:229-439-7700
Mailing Address - Fax:229-439-7283
Practice Address - Street 1:806 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2363
Practice Address - Country:US
Practice Address - Phone:229-439-7700
Practice Address - Fax:229-439-7283
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040367207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000656719JMedicaid
GA000656719IMedicaid
GA000656719HMedicaid
GA000656719IMedicaid
GA18BDFLNMedicare PIN
GA1240870001Medicare NSC
GA18BDFLN01Medicare PIN