Provider Demographics
NPI:1356466999
Name:DIX, LOUIS JOSEPH JR (PHD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:JOSEPH
Last Name:DIX
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1525 KENZIE CT
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2812
Mailing Address - Country:US
Mailing Address - Phone:770-623-1875
Mailing Address - Fax:
Practice Address - Street 1:620 BROAD STREET POWELL BUILDING OFC 205-C
Practice Address - Street 2:CENTRAL STATE HOSPITAL
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31062-7525
Practice Address - Country:US
Practice Address - Phone:478-445-7239
Practice Address - Fax:478-445-1329
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001937103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAS81788Medicare ID - Type UnspecifiedMEDICARE PART B