Kellie Anissa Dix

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC012322 Issued in GA

Practice address

1102 Smith Ave
Thomasville, GA 31792-5739

Phone

(229) 227-5449

Fax

(229) 227-2145

NPI assigned

Jul 21, 2021

Last updated

Jul 21, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1626825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626825600000",
    "number": "1942873518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 WILLIAMS ST",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317926957",
            "telephone_number": "229-224-0269",
            "fax_number": "229-227-2142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 SMITH AVE",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317925739",
            "telephone_number": "229-227-5449",
            "fax_number": "229-227-2145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIX",
        "first_name": "KELLIE",
        "middle_name": "ANISSA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-21",
        "last_updated": "2021-07-21",
        "certification_date": "2021-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC012322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LPC012322",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Thomasville",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Thomasville",
            "address_1": "1102 Smith Ave",
            "city": "Thomasville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "317925739",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tequesta Venia Diggs
• Thalia D Diggs, LCSW
• Direct Patient Care of Thomasville LLC
• Tinika Ross Dismuke, CCC-SLP
• Pranav Diwan, M.D.
• Doctors Anesthesia
• Gregory E Dodson, PAC
• Camille Domingo, MD
• Eric Laroy Donald
• Robert Michael Donovan, P.A.

• Professional Counselor in Thomasville, GA
• Providers in Thomasville, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2021; 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.