Provider Demographics
NPI:1215180278
Name:DIXON, RITA M (PAC)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:M
Last Name:DIXON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60099
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0099
Mailing Address - Country:US
Mailing Address - Phone:803-328-0181
Mailing Address - Fax:803-328-0553
Practice Address - Street 1:2450 INDIA HOOK RD
Practice Address - Street 2:SUITE B
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3270
Practice Address - Country:US
Practice Address - Phone:803-328-0181
Practice Address - Fax:803-328-0553
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCTL1366363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1366OtherSC LICENSE
260154591OtherTAX ID NUMBER
SC1366OtherSC LICENSE
SCAA33171909Medicare PIN