Provider Demographics
NPI:1598956120
Name:DIXON, TARA J (NP)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:J
Last Name:DIXON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5569 HOUSTON RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31216-5709
Mailing Address - Country:US
Mailing Address - Phone:478-781-5065
Mailing Address - Fax:478-781-0012
Practice Address - Street 1:5569 HOUSTON RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31216-5709
Practice Address - Country:US
Practice Address - Phone:478-781-5065
Practice Address - Fax:478-781-0012
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN159360363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00475216OtherRR MEDICARE
GAP00475216OtherRR MEDICARE