Individual provider · Type 1 NPI
Ty-Re Lamont Dixon Sr.
Customized Equipment (DME) · Fayetteville, GA
NPI number
1902264492
Active
Practice location
220 Shoreline Dr.
Fayetteville, GA 30215
Fax (770) 897-3777
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Customized Equipment (DME) Primary | 332BC3200X | None listed |
Customized Equipment (DME): Definition to come...
About NPI 1902264492
Ty-Re Lamont Dixon Sr.'s National Provider Identifier is 1902264492, issued on Jan 29, 2016. The primary taxonomy on file is Customized Equipment (DME) (332BC3200X), and the practice location is in Fayetteville, GA. The record was last updated on Jan 29, 2016.