Provider Demographics
NPI:1487078721
Name:DIXON, MARTHA (RD, LDN)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 SHADOW RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-8520
Mailing Address - Country:US
Mailing Address - Phone:731-664-9344
Mailing Address - Fax:
Practice Address - Street 1:430 SHADOW RIDGE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-8520
Practice Address - Country:US
Practice Address - Phone:731-664-9344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000002502133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered