Provider Demographics
NPI:1326661208
Name:DIXON, JASMINE (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 WINDSOR PLACE CIR
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-4910
Mailing Address - Country:US
Mailing Address - Phone:404-421-6508
Mailing Address - Fax:
Practice Address - Street 1:390 AUBURN AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1544
Practice Address - Country:US
Practice Address - Phone:404-577-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist