Individual
JERRY DIXON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
14337 HIGHWAY 12 W, KOSCIUSKO, MS 39090-3689
(662) 705-2210
Mailing address
PO BOX 1224, KOSCIUSKO, MS 39090-1224
(662) 705-2210
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
12/26/2019
Last updated
12/26/2019
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