Provider Demographics
NPI:1669460325
Name:DIXON, JOHN M (MD P C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:DIXON
Suffix:
Gender:M
Credentials:MD P C
Other - Prefix:
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Mailing Address - Street 1:1909 ABERDEEN RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1300
Mailing Address - Country:US
Mailing Address - Phone:229-439-7774
Mailing Address - Fax:229-883-8586
Practice Address - Street 1:1909 ABERDEEN RD
Practice Address - Street 2:SUITE 108
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1300
Practice Address - Country:US
Practice Address - Phone:229-439-7774
Practice Address - Fax:229-883-8586
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2008-04-09
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Provider Licenses
StateLicense IDTaxonomies
GA15926207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00081078AMedicaid
GA00081078AMedicaid
GA0664660001Medicare NSC