Provider Demographics
NPI:1669450953
Name:DIX, WILLIAM ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ALEXANDER
Last Name:DIX
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 48708
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-8708
Mailing Address - Country:US
Mailing Address - Phone:706-543-3449
Mailing Address - Fax:706-543-5744
Practice Address - Street 1:4017 ATLANTA HWY
Practice Address - Street 2:SUITE A
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-2212
Practice Address - Country:US
Practice Address - Phone:706-389-3065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA35243207P00000X, 207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000552912CMedicaid
GA93BDLZTMedicare PIN
GA000552912CMedicaid