Provider Demographics
NPI:1265497325
Name:DIXON, WILLIAM P (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:P
Last Name:DIXON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:404-504-5678
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:3650 STEVE REYNOLDS BLVD
Practice Address - Street 2:KAISER PERMANENTE GWINNETT COMPREHENSIVE MEDICAL CENTER
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4506
Practice Address - Country:US
Practice Address - Phone:770-931-6012
Practice Address - Fax:502-272-5117
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2022-01-10
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Provider Licenses
StateLicense IDTaxonomies
KY25227207Q00000X
GA070878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1361971Medicare PIN
KYC69444Medicare UPIN
IN196290UUMedicare PIN