Provider Demographics
NPI:1568058667
Name:HIXSON, GLYNNIS ANN
Entity Type:Individual
Prefix:
First Name:GLYNNIS
Middle Name:ANN
Last Name:HIXSON
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 1:165 OLD COACH RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-3351
Mailing Address - Country:US
Mailing Address - Phone:740-856-0526
Mailing Address - Fax:
Practice Address - Street 1:114 RENICK AVE
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2879
Practice Address - Country:US
Practice Address - Phone:740-851-4461
Practice Address - Fax:740-851-4157
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOHPAN1520259OtherANTHEM BLUECROSS BLUESHIELD