Provider Demographics
NPI:1801849716
Name:BEDFORD-DIXON, CARLA YVONNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:YVONNE
Last Name:BEDFORD-DIXON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 RALPH DAVID ABERNATHY BLVD SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-1729
Mailing Address - Country:US
Mailing Address - Phone:404-346-3487
Mailing Address - Fax:404-752-0033
Practice Address - Street 1:13010 MORRIS RD STE 600
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-5096
Practice Address - Country:US
Practice Address - Phone:678-269-4743
Practice Address - Fax:678-269-4745
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063729207Q00000X
GA60239207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4348671Medicaid
MI4348671Medicaid
MIH39962Medicare UPIN
GAH39962Medicare UPIN