Provider Demographics
NPI:1871548529
Name:DIXON, MATHEW JOSEPH (DO)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:JOSEPH
Last Name:DIXON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15759
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-2459
Mailing Address - Country:US
Mailing Address - Phone:912-355-8188
Mailing Address - Fax:912-356-6970
Practice Address - Street 1:4700 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6220
Practice Address - Country:US
Practice Address - Phone:912-350-8436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS93222085R0202X
GA0576022085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAN346968OtherWELLCARE
GA085538279AMedicaid
GAP00340706OtherRAILROAD MEDICARE
GA085538279AOtherPEACH STATE HEALTH PLAN
GA52207082001OtherBCBS
FL272812500Medicaid
GAN346968OtherWELLCARE
GAP00340706OtherRAILROAD MEDICARE