Healthcare Provider Details

I. General information

NPI: 1881768455
Provider Name (Legal Business Name): INGER DALPHINE MCCOY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 PROFESSIONAL PKWY STE 2080
DOUGLASVILLE GA
30134-5632
US

IV. Provider business mailing address

55 WHITCHER ST NE SUITE 350
MARIETTA GA
30060-1155
US

V. Phone/Fax

Practice location:
  • Phone: 678-715-5080
  • Fax: 770-528-9938
Mailing address:
  • Phone: 770-424-6893
  • Fax: 678-819-0357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN140322
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: