Provider Demographics
NPI:1881843373
Name:DIXON, ASHLEY N
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:N
Last Name:DIXON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3763 JONATHAN GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-4143
Mailing Address - Country:US
Mailing Address - Phone:470-701-4995
Mailing Address - Fax:470-998-2106
Practice Address - Street 1:3763 JONATHAN GLEN WAY SW
Practice Address - Street 2:SNELLVILLE
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-4143
Practice Address - Country:US
Practice Address - Phone:470-701-4995
Practice Address - Fax:470-998-2106
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0062711041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003205595CMedicaid