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1922069079

NPI Code Detail

MEDICARE: DR. THOMAS LYNN JOLLY MD

MEDICARE: DR. THOMAS LYNN JOLLY MD

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
1	207Q00000X	Family Medicine Physician	30659	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	5188	OTHER	ND	PARTNERS/MEDICARE CHOICE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	46733	OTHER	NC	BCBS OF NC
2	A4895	OTHER	NC	MEDCOST
3	299580	OTHER	NC	MAMSI
5	1624882	OTHER	NC	FIRST HEALTH

General Provider Information

NPI Number	:	1922069079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS LYNN JOLLY MD

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	390 W SALEM AVE
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27101-5861
Country	:	US
Telephone Number	:	336-721-2375
Fax Number	:	336-721-2394

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	09/26/2023

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Directions to “ DR. THOMAS LYNN JOLLY MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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