Provider Demographics
NPI:1558558254
Name:MIXON, BENJAMIN A (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:A
Last Name:MIXON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 11503
Mailing Address - Street 2:J402
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37401-2503
Mailing Address - Country:US
Mailing Address - Phone:423-778-3274
Mailing Address - Fax:423-778-2255
Practice Address - Street 1:910 BLACKFORD STREET
Practice Address - Street 2:J402
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-1405
Practice Address - Country:US
Practice Address - Phone:423-778-7289
Practice Address - Fax:423-778-6848
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2011-06-10
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Provider Licenses
StateLicense IDTaxonomies
TN437692080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology