Provider Demographics
NPI:1003617770
Name:DIXON, JADA L
Entity type:Individual
Prefix:
First Name:JADA
Middle Name:L
Last Name:DIXON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9174 PERSEVERANCE DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-8389
Mailing Address - Country:US
Mailing Address - Phone:803-260-9603
Mailing Address - Fax:
Practice Address - Street 1:1403 HIGHWAY 301 N
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-2165
Practice Address - Country:US
Practice Address - Phone:803-260-9603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care