Individual provider Active NPI

David McCoy Ginn, PA-C

  • Physician Assistant
  • Greenville, NC
National Provider Identifier
1104148386
Registry record updated Dec 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-06922 Issued in NC
Practice address
1401 N Memorial Dr
Greenville, NC 27834-1278
Phone
(252) 378-5862
NPI assigned
Feb 16, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-06922 NC Primary
Physician Assistant 363A00000X 006429 GA
Physician Assistant 363A00000X PA1644 NV

Addresses

Primary practice location

1401 N Memorial Dr
Greenville, NC 27834-1278

Mailing address

1401 N Memorial Dr
Greenville, NC 27834-1278
Phone (252) 378-5862

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160222001081 GA Practitioner - Physician Assistant 0244546075 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
006429GAMDPhysician Assistant
0010-06922NCMDPhysician Assistant
PA1644NVMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC CurrentSince Mar 1, 2024 Accepting new patients
Wellstar Medical Group, LLC CurrentSince Mar 1, 2024 Accepting new patients

Locations

1120 15th St
#6000
Augusta, GA 30912
Phone (706) 721-3813

1120 15th St
Bldg O107
Augusta, GA 30912

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1266278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483056000000",
    "number": "1104148386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 N MEMORIAL DR",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278341278",
            "telephone_number": "252-378-5862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 N MEMORIAL DR",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278341278",
            "telephone_number": "252-378-5862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GINN",
        "first_name": "DAVID",
        "middle_name": "MCCOY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-02-16",
        "last_updated": "2016-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-06922",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "006429",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA1644",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, NC

Sources for this page

Verify at the official NPI Registry.