Individual
JOHN RANDALL NIXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3623 LATROBE DR, STE 216, CHARLOTTE, NC 28211-1187
(704) 332-1291
(704) 332-5206
Mailing address
PO BOX 221249, CHARLOTTE, NC 28222-1249
(704) 332-1291
(704) 332-5206
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
31602
NC
2085N0700X
Neuroradiology Physician
31602
NC
2085R0202X
Diagnostic Radiology Physician
Primary
31602
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8962689
—
NC
05
—
N31602
—
SC
Enumeration date
03/24/2006
Last updated
09/12/2020
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