Dixon, Michael Wade

Dixon, Michael Wade is an individual health care provider with primary practice located at 440 Ernest W Barrett Pkwy Nw Ste 62, Kennesaw GA 30144-4918. He recently has 4 registered licenses in different health care specialties including Podiatric Medicine & Surgery Service Providers / Podiatrist, Podiatric Medicine & Surgery Service Providers / Sports Medicine, Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, Podiatric Medicine & Surgery Service Providers / Foot Surgery. Podiatric Medicine & Surgery Service Providers / Podiatrist is his primary health care specialty. Dixon, Michael Wade can be contacted via phone (770) 422-0280.

Contact Information

Primary practice address
440 Ernest W Barrett Pkwy Nw Ste 62 Kennesaw GA 30144-4918
Phone: (770) 422-0280
Fax: (770) 426-5388
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 000961 Georgia
Podiatric Medicine & Surgery Service Providers / Sports Medicine 213ES0000X 000961 Georgia
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X 000961 Georgia
Podiatric Medicine & Surgery Service Providers / Foot Surgery 213ES0131X 000961 Georgia

Profile Details

NPI number 1477557924
LBN Legal business name Dixon, Michael Wade
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 10th, 2005
Last updated Jan 14th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1477557924 NPPES
Georgia MEDICAID 000954643B

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