Provider Demographics
NPI:1952175093
Name:DIX, ROSA
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:DIX
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 1:351 HERRING RD
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1028
Mailing Address - Country:US
Mailing Address - Phone:770-253-9560
Mailing Address - Fax:
Practice Address - Street 1:351 HERRING RD
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1028
Practice Address - Country:US
Practice Address - Phone:770-253-9560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider