Individual
DIXIE MAYBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
818 CHURCH ST NE, MARIETTA, GA 30060-8981
(770) 590-4190
(770) 590-4191
Mailing address
818 CHURCH ST NE, MARIETTA, GA 30060-8981
(770) 590-4190
(770) 590-4191
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
2476
SC
363AS0400X
Surgical Physician Assistant
Primary
9782
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2450PA
—
SC
Enumeration date
11/18/2015
Last updated
02/26/2024
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