Provider Demographics
NPI:1942675533
Name:DIXON, MAXIE SHERWOOD JR
Entity Type:Individual
Prefix:MR
First Name:MAXIE
Middle Name:SHERWOOD
Last Name:DIXON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1682 MANCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609
Mailing Address - Country:US
Mailing Address - Phone:919-286-1601
Mailing Address - Fax:919-484-0899
Practice Address - Street 1:3405 HILLSBOROUGH RD STE B
Practice Address - Street 2:DURHAM FESTIVAL MALL
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3041
Practice Address - Country:US
Practice Address - Phone:919-286-1601
Practice Address - Fax:919-484-0899
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC853237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist