Provider Demographics
NPI:1689876617
Name:MCGINNIS, JEFFREY T (CO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:T
Last Name:MCGINNIS
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2034 RANDOLPH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1216
Mailing Address - Country:US
Mailing Address - Phone:704-377-7099
Mailing Address - Fax:704-377-7983
Practice Address - Street 1:2034 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1216
Practice Address - Country:US
Practice Address - Phone:704-377-7099
Practice Address - Fax:704-377-7983
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795131Medicaid