Individual
DETRA K DIXON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
227 AMALIE DR, MACON, GA 31220-2667
(478) 731-9521
Mailing address
227 AMALIE DR, MACON, GA 31220-2667
(478) 731-9521
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APRN-NP213793
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN213793
NP LICENSING NUMBER
GA
Enumeration date
06/05/2019
Last updated
10/29/2025
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