Provider Demographics
NPI:1669909172
Name:DIXIE MEDICAL
Entity type:Organization
Organization Name:DIXIE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:478-559-1386
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:CHAUNCEY
Mailing Address - State:GA
Mailing Address - Zip Code:31011-0146
Mailing Address - Country:US
Mailing Address - Phone:478-559-1386
Mailing Address - Fax:478-559-1388
Practice Address - Street 1:1085 PLAZA AVE
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-9102
Practice Address - Country:US
Practice Address - Phone:478-559-1386
Practice Address - Fax:478-559-1388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-15
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN118481261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care