Provider Demographics
NPI:1598890790
Name:HIXSON, GARY LYNN JR (CPHT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:LYNN
Last Name:HIXSON
Suffix:JR
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 MILL ST
Mailing Address - Street 2:
Mailing Address - City:DANDRIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37725-4809
Mailing Address - Country:US
Mailing Address - Phone:865-705-6120
Mailing Address - Fax:865-397-6279
Practice Address - Street 1:1224 GAY STREET
Practice Address - Street 2:
Practice Address - City:DANDRIDGE
Practice Address - State:TN
Practice Address - Zip Code:37725
Practice Address - Country:US
Practice Address - Phone:865-397-3444
Practice Address - Fax:865-397-6279
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17857183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician