Provider Demographics
NPI:1508938531
Name:MINCHEW, MARGARET S (PA)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:S
Last Name:MINCHEW
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:MARGARET
Other - Middle Name:
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31539
Mailing Address - Country:US
Mailing Address - Phone:912-384-2500
Mailing Address - Fax:912-383-6788
Practice Address - Street 1:2010 OCILLA RD
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2230
Practice Address - Country:US
Practice Address - Phone:912-384-1477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002790363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA002790OtherPHYSICIAN ASSISTANT #
GA100001771BMedicaid
GA11D0909097OtherCLIA ID
GA511I970238Medicare PIN
GAGRP7930Medicare PIN