Provider Demographics
NPI:1952622987
Name:MCGINNIS, NATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:MCGINNIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8820 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-2266
Mailing Address - Country:US
Mailing Address - Phone:770-947-3000
Mailing Address - Fax:770-947-3012
Practice Address - Street 1:5141 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-1159
Practice Address - Country:US
Practice Address - Phone:212-932-4000
Practice Address - Fax:212-209-3250
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270886207R00000X, 208M00000X
GA90103207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400125391OtherMEDICARE PTAN
NY02905719Medicaid
NY00695941Medicaid
NY00695941Medicaid
NY331946Medicare Oscar/Certification