Provider Demographics
NPI:1457345506
Name:DIXON, MARK C (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:C
Last Name:DIXON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 535744
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-5510
Mailing Address - Country:US
Mailing Address - Phone:844-294-5114
Mailing Address - Fax:865-691-0843
Practice Address - Street 1:135 W RAVINE RD
Practice Address - Street 2:STE 5B
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3847
Practice Address - Country:US
Practice Address - Phone:423-224-3460
Practice Address - Fax:423-224-3465
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2017-04-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN21110207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
050058687OtherRR MEDICARE
262469OtherANTHEM BC/BS
3066808OtherBLUE SHIELD OF TN
TN100011121Medicaid
TN3073685Medicaid
VA5708419Medicaid
00013859OtherNHC CARE ADMINISTRATORS
TN0100OtherJOHN DEERE
TN3073685Medicaid
VA5708419Medicaid