Provider Demographics
NPI:1740347434
Name:GILMORE, DIXIE (CNM)
Entity type:Individual
Prefix:
First Name:DIXIE
Middle Name:
Last Name:GILMORE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:DIXIE
Other - Middle Name:
Other - Last Name:SHEPARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:315 WINN WAY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2111
Mailing Address - Country:US
Mailing Address - Phone:404-299-9724
Mailing Address - Fax:404-299-0382
Practice Address - Street 1:315 WINN WAY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030
Practice Address - Country:US
Practice Address - Phone:404-299-9724
Practice Address - Fax:404-299-0382
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN097529367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA116976858TMedicaid
GA116976858SMedicaid