Provider Demographics
NPI:1306866199
Name:ELGIN, JOHN NICHOLS (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:NICHOLS
Last Name:ELGIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:987 SMITH MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONS GAP
Mailing Address - State:AL
Mailing Address - Zip Code:36861-2540
Mailing Address - Country:US
Mailing Address - Phone:256-329-7295
Mailing Address - Fax:
Practice Address - Street 1:3316 HIGHWAY 280
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-3369
Practice Address - Country:US
Practice Address - Phone:256-329-7295
Practice Address - Fax:256-329-7186
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18422207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00076882Medicaid
AL51076882OtherBLUE CROSS PROVIDER NUMBE
ALG70009Medicare UPIN
AL51076882Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER