Basic Information
| Provider Information | |||||||||
| NPI: | 1811988017 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NIXON | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | MD, PHD, FACS, FRCSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 658 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305030658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707181122 | ||||||||
| FaxNumber: | 7705357445 | ||||||||
| Practice Location | |||||||||
| Address1: | 1240 JESSE JEWELL PKWY | ||||||||
| Address2: | STE 300 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305013861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705347200 | ||||||||
| FaxNumber: | 6784503778 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2005 | ||||||||
| LastUpdateDate: | 03/07/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 173000000X | 036584 | GA | N | Other Service Providers | Legal Medicine | 207T00000X | 036584 | GA | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 01348318 | 01 | GA | AMERIGROUP | OTHER | 7610412 | 01 | GA | CIGNA | OTHER | P00903597 | 01 | GA | PALMETTO GBA RAILROAD MEDICARE PART B | OTHER | 000564462C | 05 | GA | MEDICAID | 000564462D | 05 | GA | MEDICAID | 52414684 | 01 | GA | BCBS | OTHER | 551630 | 01 | GA | WELLCARE | OTHER |