Mixon, Dianne S

Mixon, Dianne S is an sole proprietor health care provider with primary practice located at 1608 Meadows Ln Ste 1 , Vidalia GA 30474-9907. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Mixon, Dianne S can be contacted via phone (912) 537-9488.

Contact Information

Primary practice address
1608 Meadows Ln Ste 1 Vidalia GA 30474-9907
Phone: (912) 537-9488
Fax: (912) 537-8951
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 000330 Georgia

Profile Details

NPI number 1245376573
LBN Legal business name Mixon, Dianne S
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 30th, 2007
Last updated Dec 20th, 2010 - about 15 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 1245376573 NPPES
Georgia MEDICAID 100001382A

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