Provider Demographics
NPI:1407005614
Name:INKS, GERALD JOHN (PA-C)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:JOHN
Last Name:INKS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 GEMINI PL STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-6110
Mailing Address - Country:US
Mailing Address - Phone:614-262-4263
Mailing Address - Fax:614-262-0822
Practice Address - Street 1:1210 GEMINI PL STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-6110
Practice Address - Country:US
Practice Address - Phone:614-262-4263
Practice Address - Fax:614-262-0822
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002787363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical