Individual
DR. ELVIN COY IRVIN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
915 GORDON AVE, THOMASVILLE, GA 31792-6614
(229) 228-2000
Mailing address
915 GORDON AVE, THOMASVILLE, GA 31792-6614
(229) 228-2000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
33164
SC
207Q00000X
Family Medicine Physician
Primary
78392
GA
207Q00000X
Family Medicine Physician
ME42445
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041748300
—
FL
01
—
17583
BLUE CROSS BLUE SHIELD OF FLORIDA
FL
01
—
592-05580
BLUE CROSS BLUE SHIELD OF ALABAMA
AL
01
—
P00686500
MEDICARE RAILROAD
—
Enumeration date
11/18/2005
Last updated
09/10/2020
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