Provider Demographics
NPI:1497465348
Name:DICKSON, ROXIE JOY
Entity Type:Individual
Prefix:MRS
First Name:ROXIE
Middle Name:JOY
Last Name:DICKSON
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:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MS
Mailing Address - Zip Code:39341-0293
Mailing Address - Country:US
Mailing Address - Phone:601-938-8653
Mailing Address - Fax:
Practice Address - Street 1:2965 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MS
Practice Address - Zip Code:39341-2274
Practice Address - Country:US
Practice Address - Phone:662-788-1032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach