Provider Demographics
NPI:1275719460
Name:CLARENCE R HIXON M.D., P.C.
Entity Type:Organization
Organization Name:CLARENCE R HIXON M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-265-3333
Mailing Address - Street 1:285 BOULEVARD NE STE 440
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-4213
Mailing Address - Country:US
Mailing Address - Phone:404-265-3333
Mailing Address - Fax:404-265-3334
Practice Address - Street 1:285 BOULEVARD NE STE 440
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-4213
Practice Address - Country:US
Practice Address - Phone:404-265-3333
Practice Address - Fax:404-265-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037233174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00565012BMedicaid
02BDFWSMedicare PIN
F42192Medicare UPIN