Robert David Mixson, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

039415 Issued in GA

Practice address

104 Lakeshore Dr
Ste a
Saint Marys, GA 31558-3803

Phone

(912) 882-7100

Fax

(912) 882-9149

NPI assigned

Jun 30, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cooperative Healthcare Services Inc

  • Clinic/Center
  • Brunswick, GA
  • NPI 1417979402
  Medicare reassignment NPD

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441238400000",
    "number": "1912904459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 LAKESHORE DR",
            "address_2": "STE A",
            "city": "SAINT MARYS",
            "state": "GA",
            "postal_code": "315583803",
            "telephone_number": "912-882-7100",
            "fax_number": "912-882-9149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 LAKESHORE DR",
            "address_2": "STE A",
            "city": "SAINT MARYS",
            "state": "GA",
            "postal_code": "315583803",
            "telephone_number": "912-882-7100",
            "fax_number": "912-882-9149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIXSON",
        "first_name": "ROBERT",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-30",
        "last_updated": "2015-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "039415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Jo Meyers, MS CCC-SLP
• Aubrey E Millan
• Mason Miller, H.I.S.
• Hailey Mitchell
• Janet Beecham Mixson, L.AC., DOM
• Roxanne R Mody, M.D.
• Maurianne Montes, L.AC., M.AC.O.M.
• Cassidy Morales
• Mr Breath
• Kristen Anne Myers

• Specialist in Saint Marys, GA
• Providers in Saint Marys, GA by specialty
• Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.