Melvin Dixon, CPO
Individual provider Active NPI Orthotic Fitter · Clarkston, GA
NPI 1083672695 · NPPES record last updated Nov 6, 2007
Key facts
- NPI
- 1083672695
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthotic Fitter 225000000X
- Practice address
- 753 N Indian Creek Dr
Clarkston, GA 30021-2347 - Phone
- (404) 292-4200
- Fax
- (404) 292-4247
- NPI assigned
- May 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Premier Orthotics & Prosthetics, Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthotic Fitter | 225000000X | Yes |
Addresses
Primary practice location
753 N Indian Creek Dr
Clarkston, GA 30021-2347
Mailing address
753 N Indian Creek Dr
Clarkston, GA 30021-2347
Phone (404) 292-4200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00846513A | Medicaid | GA |
Other providers in Clarkston, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 6, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.