Provider Demographics
NPI:1679689186
Name:NIXON, BRENT PECK (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:PECK
Last Name:NIXON
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:1902 POWERS FERRY TRCE SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-6686
Mailing Address - Country:US
Mailing Address - Phone:404-321-6111
Mailing Address - Fax:404-235-3005
Practice Address - Street 1:1670 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:404-235-3005
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ339213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery