Provider Demographics
NPI:1306336862
Name:GRIGSBY, CHRISTIN LAUREN P CUMMINS (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTIN
Middle Name:LAUREN P CUMMINS
Last Name:GRIGSBY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:920 DOUG WHITE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4180
Mailing Address - Country:US
Mailing Address - Phone:843-848-1440
Mailing Address - Fax:843-839-1654
Practice Address - Street 1:920 DOUG WHITE DR STE 130
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4180
Practice Address - Country:US
Practice Address - Phone:843-848-1440
Practice Address - Fax:843-839-1654
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC5374363AS0400X
TXPA11993363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical