MEDICARE: MRS. INGER DALPHINE MCCOY NP-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	363L00000X	Nurse Practitioner	RN140322	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881768455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. INGER DALPHINE MCCOY NP-C

Provider Business Mailing Address
First Line	:	55 WHITCHER ST NE
Second Line	:	SUITE 350
City	:	MARIETTA
State	:	GA
Zip	:	30060-1155
Country	:	US
Telephone Number	:	770-424-6893
Fax Number	:	678-819-0357

Provider Business Practice Location Address
First Line	:	6001 PROFESSIONAL PKWY STE 2080
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30134-5632
Country	:	US
Telephone Number	:	678-715-5080
Fax Number	:	770-528-9938

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	03/28/2018

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