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Mr. Ty-re Lamont Dixon SR.
Customized Equipment (DME) in Fayetteville, Georgia
NPI 1902264492

Ty-re Lamont Dixon SR. is a Customized Equipment (DME) based in Fayetteville, GA and is specialized in Customized Equipment. Ty-re Lamont Dixon SR. practices in Fayetteville, GA. The NPI Number for Ty-re Lamont Dixon SR. is 1902264492 and holds a License No. (Georgia).

The current practice location address for Ty-re Lamont Dixon SR. is 220 Shoreline Dr., Fayetteville, GA and can be reached out via phone at 404-661-1800 and via fax at 770-897-3777.

Location: 220 Shoreline Dr., Fayetteville, GA, 30215
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1902264492
Provider Name
Ty-re Lamont Dixon SR.
Credential
Provider Entity Type
Individual
Gender
Male
Address
220 Shoreline Dr., Fayetteville, GA, 30215
Phone Number
404-661-1800
Fax Number
770-897-3777
Provider Enumeration Date
01/29/2016
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
220 Shoreline Dr.
City
Fayetteville
State
Georgia
Zip
30215
Phone Number
404-661-1800
Fax Number
770-897-3777
person
Provider Business Mailing Address Details
Address
220 Shoreline Dr.
City
Fayetteville
State
Georgia
Zip
30215
Phone Number
404-661-1800
Fax Number
770-897-3777
person
Provider's Taxonomy Details 1
Type
Suppliers
Classification
Durable Medical Equipment & Medical Supplies
Speciality
Customized Equipment
Taxonomy
332BC3200X
License No.
(Georgia)
Definition
Definition to come...
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