Provider Demographics
NPI:1609385673
Name:DECIA DIXON PHD LLC
Entity Type:Organization
Organization Name:DECIA DIXON PHD LLC
Other - Org Name:THE PARENT CHILD PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DECIA
Authorized Official - Middle Name:N
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:678-649-1940
Mailing Address - Street 1:2751 BUFORD HWY NE STE 410
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-5457
Mailing Address - Country:US
Mailing Address - Phone:678-649-1940
Mailing Address - Fax:
Practice Address - Street 1:2751 BUFORD HWY NE STE 410
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-5457
Practice Address - Country:US
Practice Address - Phone:404-507-6656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003490103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003125580AMedicaid