Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0208X | Pediatric Infectious Diseases | 200401048 | NC |
Y | 2080P0208X | Pediatric Infectious Diseases | 31824 | SC |
NPI | 1427223429 |
---|---|
Provider Name | Dr. Terry Carlyle Dixon |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-8900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2008 |
Last Update Date | 06/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AD3189380-TD13 | (02) |