Individual
DR. MICHAEL WADE DIXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
440 ERNEST W BARRETT PKWY NW, STE 62, KENNESAW, GA 30144-4918
(770) 422-0280
(770) 426-5388
Mailing address
440 ERNEST W BARRETT PKWY NW, STE 62, KENNESAW, GA 30144-4918
(770) 422-0280
(770) 426-5388
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
000961
GA
213ES0000X
Sports Medicine Podiatrist
000961
GA
213ES0103X
Foot & Ankle Surgery Podiatrist
000961
GA
213ES0131X
Foot Surgery Podiatrist
000961
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000954643B
—
GA
Enumeration date
06/10/2005
Last updated
01/14/2014
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