Provider Demographics
NPI:1104148386
Name:GINN, DAVID MCCOY (PA-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MCCOY
Last Name:GINN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 N MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-1278
Mailing Address - Country:US
Mailing Address - Phone:252-378-5862
Mailing Address - Fax:
Practice Address - Street 1:1401 N MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-1278
Practice Address - Country:US
Practice Address - Phone:252-378-5862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06922363A00000X
GA006429363A00000X
NVPA1644363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant