Georgina Lenore Dixon Carlson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

25611 Issued in MN

Practice address

1500 Curve Crest Boulevard
Stillwater Medical Group
Stillwater, MN 55082-6040

Phone

(651) 439-1234

Fax

(651) 275-3325

NPI assigned

Dec 21, 2005

Last updated

Jun 6, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338940800000",
    "number": "1174509137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 CURVE CREST BOULEVARD",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550826040",
            "telephone_number": "651-439-1234",
            "fax_number": "651-275-3325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 CURVE CREST BOULEVARD",
            "address_2": "STILLWATER MEDICAL GROUP",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550826040",
            "telephone_number": "651-439-1234",
            "fax_number": "651-275-3325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "GEORGINA",
        "middle_name": "LENORE DIXON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-21",
        "last_updated": "2012-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "25611",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "885563300",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32108100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Suzanne M. Carlson-Shimon, FNP-BC
• Douglas J Carlson, M.D.
• Duane M Carlson, LADC
• Erik Carlson, D.C.
• Erin Carlson, MD
• Glenna Ruth Carlson
• Harmony Ann Carlson, PSY.D., LP
• Sarah L Carlson, D.D.S.
• Wayne Donald Carlson, MD
• David Carroll, PSYD, LP

• Family Medicine Physician in Stillwater, MN
• Providers in Stillwater, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.