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NPI Code Detail

MEDICARE: MR. ROBERT LEE HOLLINGSWORTH PA-C

MEDICARE: MR. ROBERT LEE HOLLINGSWORTH PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant100599NC
2363AM0700XMedical Physician Assistant100599NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164406922
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROBERT LEE HOLLINGSWORTH PA-C
Provider Business Mailing Address
First Line : 2170 MIDLAND RD
Second Line :
City : SOUTHERN PINES
State : NC
Zip : 28387-2999
Country : US
Telephone Number : 910-295-2100
Fax Number : 910-295-3625
Provider Business Practice Location Address
First Line : 2170 MIDLAND RD
Second Line :
City : SOUTHERN PINES
State : NC
Zip : 28387-2999
Country : US
Telephone Number : 910-295-2100
Fax Number : 910-295-3625
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2005
Last Update Date : 04/20/2022

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