Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Ty-Re Lamont Dixon Sr.

Individual provider Customized Equipment (DME) · NPI 1902264492

Mr. Ty-Re Lamont Dixon Sr. is a Customized Equipment (DME) in Fayetteville, Georgia. Practices as a sole proprietor. Licensed in Georgia.

Licensed in
GA
In the registry since
2016
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Practice location Address checks out

220 Shoreline Dr
Fayetteville, GA 30215 Not confirmed with CMS for 10 years — call before visiting
Phone: (404) 661-1800
Fax: (770) 897-3777
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Customized Equipment (DME) (primary) Taxonomy 332BC3200X (GA)

Record details

NPI number1902264492
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJanuary 29, 2016
Last updated in NPPESJanuary 29, 2016