Individual
MR. TY-RE LAMONT DIXON SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
220 SHORELINE DR., FAYETTEVILLE, GA 30215
(404) 661-1800
(770) 897-3777
Mailing address
220 SHORELINE DR., FAYETTEVILLE, GA 30215
(404) 661-1800
(770) 897-3777
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
GA
Other
Enumeration date
01/29/2016
Last updated
01/29/2016
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