MEDICARE: CHRISTIN LAUREN P CUMMINS GRIGSBY PA-C

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	363AS0400X	Surgical Physician Assistant	5374	SC
2	363AS0400X	Surgical Physician Assistant	PA11993	TX

General Provider Information

NPI Number	:	1306336862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIN LAUREN P CUMMINS GRIGSBY PA-C

Provider Business Mailing Address
First Line	:	3793 MCDOWELL LN STE 100
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-7892
Country	:	US
Telephone Number	:	843-390-0100
Fax Number	:

Provider Business Practice Location Address
First Line	:	3793 MCDOWELL LN STE 100
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-7892
Country	:	US
Telephone Number	:	843-390-0100
Fax Number	:

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

Provider Enumeration Date	:	05/10/2018
Last Update Date	:	06/04/2026

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