Provider Demographics
NPI:1679178362
Name:DIXON & MATHEW GROUP LLC
Entity Type:Organization
Organization Name:DIXON & MATHEW GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DEWITT
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:704-840-5662
Mailing Address - Street 1:6823 WAGON OAK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-8580
Mailing Address - Country:US
Mailing Address - Phone:704-840-5662
Mailing Address - Fax:
Practice Address - Street 1:6823 WAGON OAK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8580
Practice Address - Country:US
Practice Address - Phone:704-840-5662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities