MEDICARE: MR. ALTON K. DINKINS 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	363A00000X	Physician Assistant	3749	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100001691B	OTHER	GA	PEACH STATE HEALTH PLAN
2	800791	OTHER	GA	BLUE SHIELD
3	336104	OTHER	GA	WELLCARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588627632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALTON K. DINKINS PA-C

Provider Business Mailing Address
First Line	:	1 DOCTORS PARK
Second Line	:
City	:	CAIRO
State	:	GA
Zip	:	39828-3072
Country	:	US
Telephone Number	:	229-378-8110
Fax Number	:	229-378-8109

Provider Business Practice Location Address
First Line	:	1 DOCTORS PARK
Second Line	:
City	:	CAIRO
State	:	GA
Zip	:	39828-3072
Country	:	US
Telephone Number	:	229-378-8110
Fax Number	:	229-378-8109

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	03/23/2010

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