Provider Demographics
NPI:1609849272
Name:DIXON, JAMES GRAYSON (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GRAYSON
Last Name:DIXON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-5955
Mailing Address - Fax:757-446-5196
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-5955
Practice Address - Fax:757-446-5196
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010343661207R00000X
VA0101034661207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006026001Medicaid
VA227456OtherUHC/MAMSI
NC890516KMedicaid
NC0516KOtherBC/BS
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
VA332674OtherANTHEM
VAPAROtherCIGNA
VAPAROtherVA HEALTH NETWORK
VAPAROtherMULTIPLAN
VAPAROtherUSA MANAGED CARE
VA12095OtherSENTARA OPTIMA
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherCORVEL/CORCARE
VA-002 -003OtherTRICARE/CHAMPUS
VA005612829Medicaid
VAPAROtherAETNA
VA110002703Medicare PIN
VAPAROtherCORVEL/CORCARE
VAPAROtherVIRGINIA PREMIER HEALTH