Provider Demographics
NPI:1447286893
Name:HIXON, CLARENCE R (MD, FACS)
Entity type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:R
Last Name:HIXON
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 BOULEVARD NE
Mailing Address - Street 2:SUITE 440
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-4205
Mailing Address - Country:US
Mailing Address - Phone:404-265-3333
Mailing Address - Fax:404-265-3334
Practice Address - Street 1:285 BOULEVARD NE
Practice Address - Street 2:SUITE 440
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-4205
Practice Address - Country:US
Practice Address - Phone:404-265-3333
Practice Address - Fax:404-265-3334
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037233174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00565012BMedicaid
GA02BDFWSMedicare ID - Type Unspecified
GAF42192Medicare UPIN