Provider Demographics
NPI:1184657017
Name:DIXON, RAY ASHLEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:ASHLEY
Last Name:DIXON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5857 LANES BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-6503
Mailing Address - Country:US
Mailing Address - Phone:912-530-6813
Mailing Address - Fax:912-367-7235
Practice Address - Street 1:34 NW PARK AVE
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-0049
Practice Address - Country:US
Practice Address - Phone:912-367-2488
Practice Address - Fax:912-367-7235
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA21788183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist