Provider Demographics
NPI:1366691271
Name:NIXON, JANICE
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:NIXON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6315 N TYLER CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-4232
Mailing Address - Country:US
Mailing Address - Phone:912-532-3889
Mailing Address - Fax:
Practice Address - Street 1:5617 PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3480
Practice Address - Country:US
Practice Address - Phone:706-257-7722
Practice Address - Fax:706-257-7723
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003989101YM0800X
GALPC004000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1700244415Medicaid