Provider Demographics
NPI:1588627632
Name:DINKINS, ALTON K (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ALTON
Middle Name:K
Last Name:DINKINS
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 1:1 DOCTORS PARK
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:GA
Mailing Address - Zip Code:39828-3072
Mailing Address - Country:US
Mailing Address - Phone:229-378-8110
Mailing Address - Fax:229-378-8109
Practice Address - Street 1:1 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:39828-3072
Practice Address - Country:US
Practice Address - Phone:229-378-8110
Practice Address - Fax:229-378-8109
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3749363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100001691BOtherPEACH STATE HEALTH PLAN
GA800791OtherBLUE SHIELD
GA336104OtherWELLCARE
GA100001691BMedicaid
P35187Medicare UPIN