Provider Demographics
NPI:1619149473
Name:MIDGETT, JOHN DAMERON (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DAMERON
Last Name:MIDGETT
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:4615 OLEANDER DR
Mailing Address - Street 2:SUITE 201-A
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5741
Mailing Address - Country:US
Mailing Address - Phone:843-497-5929
Mailing Address - Fax:843-497-6601
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-3350
Practice Address - Country:US
Practice Address - Phone:843-497-5929
Practice Address - Fax:843-497-6601
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2008-05-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-01286363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant