Healthcare Provider Details

I. General information

NPI: 1225886518
Provider Name (Legal Business Name): JASON PLYMALE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 GLENSFORD DR
FAYETTEVILLE NC
28314-0892
US

IV. Provider business mailing address

217 GLENSFORD DR
FAYETTEVILLE NC
28314-0892
US

V. Phone/Fax

Practice location:
  • Phone: 910-483-4647
  • Fax: 910-483-6434
Mailing address:
  • Phone: 910-483-4647
  • Fax: 910-483-6434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: