Ethan Irvin, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

655 7TH St BLDG 700
Robins Afb, GA 31098-2227

Phone

(478) 497-7569

NPI assigned

Aug 11, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1628640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690502400000",
    "number": "1538834619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2803 MEDICAL CAMPUS DR",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "27531",
            "telephone_number": "919-722-1802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 7TH ST BLDG 700",
            "city": "ROBINS AFB",
            "state": "GA",
            "postal_code": "310982227",
            "telephone_number": "478-497-7569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IRVIN",
        "first_name": "ETHAN",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-08-11",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Virginia Ann Holloway, P.I.P, LCSW
• Douglas C. Holmes, DMD
• HQ Air Force Reserve Command
• Tandra Hunter, LMSW
• Gregory Scott Hyland, MD
• Phyllis D Ivery, PH.D.
• Jon Morris Johnson, M.D.
• Stephanie Hillsman Johnson, LCSW
• Valerie V T Johnson, M.D.
• John A Kauderman Jr., OD

• Physician Assistant in Robins Afb, GA
• Providers in Robins Afb, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.