Healthcare Provider Details

I. General information

NPI: 1023134079
Provider Name (Legal Business Name): SHAWN ALAN MCCARTHY PA-C, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 01/12/2022
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 BOWMAN GRAY DR
GREENVILLE NC
27834-7286
US

IV. Provider business mailing address

3937 COLONY WOODS DR
GREENVILLE NC
27834-6868
US

V. Phone/Fax

Practice location:
  • Phone: 252-816-4001
  • Fax:
Mailing address:
  • Phone: 302-598-5392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: