Provider Demographics
NPI:1790905867
Name:ADKINS, CORINNE M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CORINNE
Middle Name:M
Last Name:ADKINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:GRAND STAND PEDIATRICS
Mailing Address - Street 2:8120 ROURK STREET
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572
Mailing Address - Country:US
Mailing Address - Phone:843-449-1438
Mailing Address - Fax:843-206-1349
Practice Address - Street 1:GRAND STAND PEDIATRICS
Practice Address - Street 2:8120 ROURK STREET
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572
Practice Address - Country:US
Practice Address - Phone:843-449-1438
Practice Address - Fax:843-206-1349
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001977208000000X
SC3262208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110001977OtherDEPT OF HEALTH PROFESSION