Provider Demographics
NPI:1710640669
Name:DIXON, MARY BETH (PA-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:DIXON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 SHRINE RD STE A
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4357
Mailing Address - Country:US
Mailing Address - Phone:912-264-6303
Mailing Address - Fax:912-264-6323
Practice Address - Street 1:3222 SHRINE RD STE A
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4357
Practice Address - Country:US
Practice Address - Phone:912-264-6303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10729363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical