Provider Demographics
NPI:1659865087
Name:DIXON, PHYLLIS FRANKLIN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:FRANKLIN
Last Name:DIXON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:TWIN CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30471-4775
Mailing Address - Country:US
Mailing Address - Phone:478-494-0421
Mailing Address - Fax:
Practice Address - Street 1:118 ALICE COLEMAN DR
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474
Practice Address - Country:US
Practice Address - Phone:912-537-6565
Practice Address - Fax:478-237-9138
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF06180075363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily