Provider Demographics
NPI:1083672695
Name:DIXON, MELVIN (CPO)
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:
Last Name:DIXON
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 N INDIAN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-2347
Mailing Address - Country:US
Mailing Address - Phone:404-292-4200
Mailing Address - Fax:404-292-4247
Practice Address - Street 1:753 N INDIAN CREEK DR
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021-2347
Practice Address - Country:US
Practice Address - Phone:404-292-4200
Practice Address - Fax:404-292-4247
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00846513AMedicaid
GA1294340001Medicare NSC