Provider Demographics
NPI:1881768455
Name:MCCOY, INGER DALPHINE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:INGER
Middle Name:DALPHINE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WHITCHER ST NE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1155
Mailing Address - Country:US
Mailing Address - Phone:770-424-6893
Mailing Address - Fax:678-819-0357
Practice Address - Street 1:6001 PROFESSIONAL PKWY STE 2080
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5632
Practice Address - Country:US
Practice Address - Phone:678-715-5080
Practice Address - Fax:770-528-9938
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN140322363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003108313CMedicaid
GA003108313AMedicaid
GA003108313BMedicaid
GA003108313BMedicaid
GA003108313CMedicaid