Provider Demographics
NPI:1750522553
Name:MEDDERS, SHIRA DIXON (PT, DPT, ATC, MTC)
Entity type:Individual
Prefix:
First Name:SHIRA
Middle Name:DIXON
Last Name:MEDDERS
Suffix:
Gender:F
Credentials:PT, DPT, ATC, MTC
Other - Prefix:
Other - First Name:SHIRA
Other - Middle Name:ANN
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, ATC, MTC
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:303 S WAYNE ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:GA
Practice Address - Zip Code:31510-2921
Practice Address - Country:US
Practice Address - Phone:912-632-5824
Practice Address - Fax:912-632-5894
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009555225100000X
GA0307021362255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer