MEDICARE: DR. CODY MCGINNIS PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	1653	SC

General Provider Information

NPI Number	:	1205403953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CODY MCGINNIS PSYD

Provider Business Mailing Address
First Line	:	4000 FABER PLACE DR STE 300
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-8587
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 FABER PLACE DR STE 300
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-8587
Country	:	US
Telephone Number	:	919-436-3751
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2021
Last Update Date	:	10/05/2021

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