Provider Demographics
NPI:1336105188
Name:DIXON, ELIZABETH M (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:DIXON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 ANSON AVE
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-1134
Mailing Address - Country:US
Mailing Address - Phone:502-435-0198
Mailing Address - Fax:770-709-6910
Practice Address - Street 1:3925 JOHNS CREEK COURT
Practice Address - Street 2:SUTIE A
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024
Practice Address - Country:US
Practice Address - Phone:770-709-6922
Practice Address - Fax:770-709-6910
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT61985207Q00000X
OH35.134792207Q00000X
DEC1-0012870207Q00000X
TN58114207Q00000X
FLME138304207Q00000X
GA070877207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY023757OtherSIHO
KYP00293086OtherRAILROAD MEDICARE
KY64273162Medicaid
000000381952OtherANTHEM - NICC
KY000000756575OtherANTHEM- NCMA
IN201055170Medicaid
KY50037115OtherPASSPORT
000000381952OtherANTHEM - NICC
KY1361972Medicare PIN
KY023757OtherSIHO
KYE46499Medicare UPIN