Provider Demographics
NPI:1144334798
Name:DIXON, MARTIN A (DO)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:A
Last Name:DIXON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 PEACHTREE INDUSTRIAL BLVD STE 4101
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4542
Mailing Address - Country:US
Mailing Address - Phone:770-831-5525
Mailing Address - Fax:
Practice Address - Street 1:8225 MALL PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-6994
Practice Address - Country:US
Practice Address - Phone:770-981-2100
Practice Address - Fax:770-808-8445
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA28531207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080083028OtherMEDICARE RAILROAD
GA00462536CMedicaid
GA202I938391Medicare PIN
080083028OtherMEDICARE RAILROAD
08LCCDLMedicare PIN
GA00462536CMedicaid