Provider Demographics
NPI:1265492193
Name:NIXON, W HAROLD (MD)
Entity Type:Individual
Prefix:
First Name:W
Middle Name:HAROLD
Last Name:NIXON
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 1:391 SERPENTINE DR
Mailing Address - Street 2:SUITE500
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303
Mailing Address - Country:US
Mailing Address - Phone:864-585-8221
Mailing Address - Fax:864-216-4290
Practice Address - Street 1:391 SERPENTINE DR
Practice Address - Street 2:SUITE500
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303
Practice Address - Country:US
Practice Address - Phone:864-585-8221
Practice Address - Fax:864-216-4290
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6512174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC065128Medicaid
SC065128Medicaid