Provider Demographics
NPI:1487647582
Name:CUNNINGHAM, DIXON COURSON JR (MD)
Entity type:Individual
Prefix:MR
First Name:DIXON
Middle Name:COURSON
Last Name:CUNNINGHAM
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 100174
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3174
Mailing Address - Country:US
Mailing Address - Phone:864-226-7636
Mailing Address - Fax:864-231-7743
Practice Address - Street 1:2000 E GREENVILLE ST
Practice Address - Street 2:SUITE 2800
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1580
Practice Address - Country:US
Practice Address - Phone:864-226-7636
Practice Address - Fax:864-231-7743
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2017-03-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC223462084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT64999Medicaid
G38743Medicare ID - Type Unspecified
SCT64999Medicaid