Provider Demographics
NPI:1952917346
Name:MIXON, SARAH BISHOP (RD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:BISHOP
Last Name:MIXON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 FALLS RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-7569
Mailing Address - Country:US
Mailing Address - Phone:803-517-4453
Mailing Address - Fax:
Practice Address - Street 1:755 FALLS RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-7569
Practice Address - Country:US
Practice Address - Phone:803-517-4453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered