Provider Demographics
NPI:1821279589
Name:HERRINGTON, MEGAN WHITLEY (PA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:WHITLEY
Last Name:HERRINGTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-9305
Mailing Address - Country:US
Mailing Address - Phone:910-662-9500
Mailing Address - Fax:
Practice Address - Street 1:1500 PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7356
Practice Address - Country:US
Practice Address - Phone:910-662-9500
Practice Address - Fax:910-665-9501
Is Sole Proprietor?:No
Enumeration Date:2007-11-21
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01006363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1821279589Medicaid
NC8101682Medicaid
MW1635892OtherDEA
NC1821279589Medicaid
NC2760021BMedicare PIN