Provider Demographics
NPI:1508257627
Name:DIXON, RAYMOND LEE
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:LEE
Last Name:DIXON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 N LUMPKIN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31903-1653
Mailing Address - Country:US
Mailing Address - Phone:706-442-7069
Mailing Address - Fax:706-596-0424
Practice Address - Street 1:2401 BUENA VISTA RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-3142
Practice Address - Country:US
Practice Address - Phone:706-323-7244
Practice Address - Fax:706-596-0424
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker