Provider Demographics
NPI:1508949074
Name:MCGHIN, JADAN PINCKNEY (NP)
Entity Type:Individual
Prefix:
First Name:JADAN
Middle Name:PINCKNEY
Last Name:MCGHIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3798 OLD VINE WAY
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605
Mailing Address - Country:US
Mailing Address - Phone:229-671-9061
Mailing Address - Fax:229-245-8432
Practice Address - Street 1:601 N LEE ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-4725
Practice Address - Country:US
Practice Address - Phone:229-247-8025
Practice Address - Fax:229-245-8432
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN149417363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA656217909AMedicaid
GA656217909AMedicaid