Provider Demographics
NPI:1114514817
Name:DIXON, CHELSEA CHIMERE (CPHT)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:CHIMERE
Last Name:DIXON
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 HUGHES CT SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-7896
Mailing Address - Country:US
Mailing Address - Phone:770-313-3806
Mailing Address - Fax:
Practice Address - Street 1:303 PEACHTREE CENTER AVE NE STE 600
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-1277
Practice Address - Country:US
Practice Address - Phone:470-408-7142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHTC0002010183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician