Provider Demographics
NPI:1902888357
Name:IRVIN, ELVIN COY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ELVIN
Middle Name:COY
Last Name:IRVIN
Suffix:JR
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 1:915 GORDON AVE
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6614
Mailing Address - Country:US
Mailing Address - Phone:229-228-2000
Mailing Address - Fax:
Practice Address - Street 1:915 GORDON AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6614
Practice Address - Country:US
Practice Address - Phone:229-228-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42445207Q00000X
SC33164207Q00000X
GA78392207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041748300Medicaid
FL17583OtherBLUE CROSS BLUE SHIELD OF FLORIDA
AL592-05580OtherBLUE CROSS BLUE SHIELD OF ALABAMA
P00686500OtherMEDICARE RAILROAD
SCAA6295Medicare UPIN
FL17583YMedicare ID - Type Unspecified
FL17583OtherBLUE CROSS BLUE SHIELD OF FLORIDA
FL17583XMedicare PIN